Abstract
Introduction
Isolated long thoracic nerve injury causes paralysis of the serratus anterior muscle. Patients with serratus anterior palsy may present with periscapular pain, weakness, limitation of shoulder elevation and scapular winging.
Case presentation
We present the case of a 23-year-old woman who sustained isolated long thoracic nerve palsy during anterior spinal surgery which caused external compressive force on the nerve.
Conclusion
During positioning of patients into the lateral decubitus position, the course of the long thoracic nerve must be attended to carefully and the nerve should be protected from any external pressure.
Introduction
Isolated long thoracic nerve paralysis causes weakness of the serratus anterior muscle and winging of the scapula1,2. The normal function of the serratus anterior muscle is to maintain the scapula in apposition to the thorax when the arm is elevated forward at the shoulder1. Paralysis of the serratus anterior muscle causes the scapula to rotate posteriorly on its vertical axis, producing the characteristic appearance of winging of the scapula1,2. So far, several traumatic and non-traumatic causes of damage to the long thoracic nerve have been reported3,4. We present a patient with long thoracic nerve palsy caused by the direct compression of the nerve during anterior spinal surgery. To the best of our knowledge this is the first case report of this complication in the literature.
Case presentation
| Figure 1Initial radiographs. The initial trauma caused L1-L2 flexion-distraction injury. The patient was first treated by posterior spinal fusion and instrumentation from T11 to L3. |
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Our patient was a 23-year-old woman with a history of a car accident and an L1 flexion-distraction injury, which had been treated in another center by posterior spinal fusion and instrumentation with Cotrel-Dubousset (Figure 1). Nine months later she was referred to our department because of the failure of the instrumentation and resultant thoracolumbar kyphosis (Figure 2). She was neurologically intact. We first removed the failed instrument via a posterior approach; a week later anterior spinal release and fusion was performed. In this procedure the patient was positioned in the right lateral decubitus position (right side down) with the table flexed and a rolled towel under her axilla in order to remove the pressure from the brachial plexus and
| Figure 2Nine months after the primary surgery. Nine months after the primary operation the patient presented with implant failure and thoracolumbar kyphosis. |
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axillary vessels. Her spine was exposed by the left thoracoabdominal approach and the tenth rib resected. In the third stage,one week later, she un