Pneumothorax in the Setting of Spinal Surgery: A Case Report and Review of the Literature

Abstract

The purpose of this paper is to review the occurrence and management of a tension pneumothorax, which was exacerbated status post posterior spinal surgery. A retrospective review of intraoperative reports, imaging, and pertinent medical records was conducted for a patient who underwent posterior spinal surgery with a tiny apical pneumothorax, which subsequently developed into a major pneumothorax. The clinical signs imperative to recognition and prompt treatment are discussed. Our case report demonstrates that the unrecognized disruption of the pleural cavity during posterior spinal surgery caused the exacerbation of the patient's bilateral pneumothoraces. The patient was successfully treated with finger thoracostomy and chest tube insertion. In conclusion, posterior spinal surgery is an invasive procedure with the potential for serious complications such as the exacerbation of a previous non-surgical pneumothorax. A low index of suspicion is imperative due to the potentially lethal nature of pneumothoraces. Vital signs, pulmonary exam findings, portable radiography, and sonography equipment are all invaluable to the accurate diagnosis and early intervention of patients with pneumothoraces.

Keywords: pneumothorax; spinal surgery; surgery; surgery complication; trauma; trauma surgery.

Figure 1. Small right pneumothorax.

(A) Axial CT image shows a small amount of air in the pleural space anteriorly, bounded by the visceral pleura (white arrow) and the parietal pleura/chest wall (black arrow). (B) A portable supine chest radiograph fails to demonstrate a pneumothorax of this size.

Figure 2. Acute unstable spinal injury.

(A) Sagittal CT image shows a fracture of T12, extending through the vertebral body and posterior elements (black arrows). (B) Intraoperative lateral fluoroscopic image shows the placement of posterior fixation instrumentation including bilateral pedicle screws in the lower thoracic spine.

Figure 3. Large bilateral pneumothorax.

(A) Supine frontal chest radiograph shows extensive lucency in the lower thorax bilaterally. Note the deep costophrenic sulci (arrows). (B) Portable chest radiograph after bilateral chest tube placement demonstrates re-expansion of both lungs.