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Background: To present a patient with adolescent idiopathic scoliosis who developed a significant neurological deficit after posterior spinal fusion, in association with anemia on postoperative day two. Case Report: A 14-year-old otherwise healthy female underwent a T3-L3 instrumented posterior spinal fusion for idiopathic scoliosis which was uneventful. Immediate post-operative clinical examination was unremarkable but at postoperative day three the patient developed generalized lower extremity weakness with inability to stand and an urinary retention needing continuous intermittent catheterization program. Her hemoglobin (Hg) dropped from 10 g/dL on postoperative day one to 6.2 g/dL at day two, despite no significant bleeding was noticed. Compressive etiology was ruled out by postoperative myelogram-CT. The patient started to improve significantly after transfusion support. At three months follow-up the patient was neurologically normal. Conclusion: Close clinical neurological evaluation over 48 to 72 hours is needed in order to detect unexpected delayed paralysis following scoliosis surgery. Level of Evidence: IV.

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OBJECTIVE: We present a sternoclavicular dislocation as a non-reported complication after spinal kyphotic deformity surgical correction. BACKGROUND: The sternocostal complex seems to have an important role in the pathology of Scheuermann's kyphotic deformity. A role for the sternoclavicular complex has never been reported in association with Scheuermann's disease pathology but could explain anterior sternoclavicular dislocation after spinal kyphotic deformity correction. METHODS: A 19-year-old male patient underwent surgery for a 74° thoracic kyphosis associated with a 35° thoracic and a 50° lumbar scoliotic curve. In the early post-operative period, the patient developed pain over the left sternoclavicular joint articulation, with a very obvious lump. An X-ray disclosed an anterior sternoclavicular dislocation. After surgical treatment failed, the dislocation was repaired in a second surgical procedure with a flexion and lengthening osteotomy of the middle third of the clavicle followed by capsular repair reinforced with sternocleidomastoid fascia. RESULTS: At an 8-year follow-up after his spine procedure and 6 years after his clavicular surgery, the patient had full shoulder range of motion and no joint pain, despite the presence of a new sternoclavicular anterior dislocation. CONCLUSION: Sternoclavicular dislocation after spine kyphotic deformity correction is presented for the first time; however, it is not possible to establish a causative association. Additional studies are necessary to delineate the role of the sternoclavicular complex in Scheuermann's disease.

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Late neurological deficit following scoliosis surgery is a rare event and any change in the patient's neurological status deserves immediate attention. We report on two clinical cases (at 2 and 6 years of follow-up) where two different types of proximal instrumentation resulted in lateral drift into the spinal canal causing cord compression with neurological deficit. Late neurological compromise in a posterior spinal-fusion setting deserves a prompt and complete spine investigative search for non-union, infection, or implant migration into the spinal canal.

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INTRODUCTION: The anterior elements of the spine, particularly the odontoid processes, are a rare location for osteoblastomas. Pseudomalignant osteoblastomas are themselves rare histologic types and are also extremely rare in this location. Most osteoblastomas are Enneking stage 2 lesions; less frequently, they can be more aggressive with extra-capsular extension (Enneking stage 3). En bloc resection is recommended for aggressive lesions, but the literature is less clear regarding the approach to stage 2 tumors, particularly those with pseudomalignant histologic features. CASE REPORT: A 6-year-old male child presented with a type III pathologic fracture of the odontoid. The fracture healed but upon 6-month follow-up CT scanning, an expansile lesion was detected. Surgical biopsy revealed an osteoblastoma which was treated with intralesional excision. Meanwhile, the excised specimen showed histological features of a pseudomalignant osteoblastoma. Despite this diagnosis, no further treatment was undertaken. At a 10-year follow-up, the patient was free from pain and had full range of motion of the cervical spine; no recurrence was detected. CONCLUSION: This unique case of odontoid osteoblastoma illustrates that malignant behavior may not be predicted only by the presence of pseudomalignant features on histology.

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