Post-operative Horner's Syndrome: A Rare Complication Following Posterior Scoliosis Surgery in a Patient With Syringomyelia

Abstract

Horner's syndrome following posterior spinal instrumentation for scoliosis has been rarely reported. We describe the case of a 15-year-old male who presented with right-sided ptosis, miosis, and anhidrosis after scoliosis correction. This is the first reported case of first-order Horner's syndrome developing after scoliosis repair via posterior fixation in a patient known to have asymptomatic syringomyelia. The impression was that Horner's syndrome developed secondary to increased traction of the syringomyelia after scoliosis repair. This is significant as a diagnosis of Horner's syndrome can be distressing to patients and chronic cases cause cosmetic defects that might require surgical correction. We suggest that similar patients should be warned pre-operatively given the psychological distress associated with chronic Horner's syndrome. This case also illustrates the importance of an appropriate workup to rule out other sinister pathologies that can cause Horner's syndrome.

Keywords: horner’s syndrome; paediatric surgery; posterior spinal fixation and fusion; scoliosis surgery; spinal surgery; syringomyelia.

Figure 1. Pre-operative scoliogram. (A) Lateral view. (B) AP view.

AP, anteroposterior.

Figure 2. Pre-operative MRI spine. Note the short segment syringomyelia. It extends from the level of the C5/6 disc space to the inferior end-plate of C7, superior to the level of the ciliospinal centre of Budge and Waller.

Figure 3. Post-operative scoliogram showing adequate vertebral alignment. (A) Lateral view. (B) AP view.

AP, anteroposterior.

Figure 4. Chest X-ray performed for septic screen. The internal jugular vein central venous catheter is visible as indicated by the arrow.

Figure 5. CT angiogram of head and neck. No carotid artery dissection was identified.