Deep Sulcus Sign Revealing Occult Pneumothorax After Lumbar Spine Surgery: A Case Report

Pneumothorax is a rare but potentially serious complication following posterior spinal fixation. We report the case of an 80-year-old woman who developed a left-sided pneumothorax after posterior fixation with percutaneous pedicle screws (PPS) for an L1 burst fracture. The procedure was uneventful, with no significant changes in intraoperative vital signs, and the patient remained asymptomatic postoperatively. However, routine postoperative radiographs revealed a left-sided pneumothorax, indicated by a deep sulcus sign. A chest tube was promptly inserted, resulting in resolution of the pneumothorax without recurrence. Postoperative computed tomography confirmed proper pedicle screw placement without evidence of mispositioning. This case illustrates the importance of recognizing subtle radiological signs of pneumothorax in postoperative imaging, even in the absence of symptoms. Routine collaboration between orthopedic surgeons and radiologists can help detect such complications early and allow for timely intervention, which is essential to avoid adverse outcomes.