Intraoperative tension pneumothorax during posterior vertebral column resection in a child with congenital scoliosis

Intraoperative tension pneumothorax (TPT) is extremely rare in spinal surgery overall and particularly in extensive deformity procedures. Here, we report a TPT occurring in conjunction with posterior vertebral column resection (pVCR) for the treatment of congenital scoliosis. A 12-year-old female undergoing congenital thoracic scoliosis surgery (e.g., pVCR) developed abrupt intraoperative increases in airway pressure and compromised hemodynamics that led to a TPT. This was directly attributed to an inadvertent pleural tear. Temporary drainage of the accumulated air was accomplished with a urethral catheter inserted directly into the pleural cavity. This was later supplemented with a standard chest tube. The child quickly improved and was routinely discharged a few days later. In patients undergoing pVCR, if the surgical team is faced with unexplained hemodynamic instability and increased airway resistance, a TPT should be strongly suspected and appropriately managed.