Delayed Cervical Spinal Cord Injury After Thoracolumbar Scoliosis Correction: A Case Report and Review of the Literature

We report the case of a 13-year-old female with progressive adolescent idiopathic scoliosis (AIS) who developed a delayed neurological deficit following T1-L3 posterior spinal fusion. Preoperatively, she had a 74° left proximal thoracic curve and a 96° right main thoracic curve. Surgery was uneventful, with stable intraoperative neuromonitoring and normal immediate neurological status. Twelve hours postoperatively, she developed progressive quadriplegia, preceded by episodes of hypotension. She was taken back to the theatre for implant removal and curve relaxation, but her deficit did not improve. Whole-spine MRI revealed extensive cervical cord oedema from C3 to T1. High-dose methylprednisolone and hemodynamic optimisation led to mild neurological improvement. After six months, she demonstrated partial recovery of upper limb strength, though she remained wheelchair-bound. At one year, she regained limited lower limb function and was able to ambulate short distances with a walking frame. This report highlights an extremely rare but catastrophic complication of scoliosis correction surgery and underscores the importance of vigilant postoperative monitoring.