Case: In a patient who underwent a thoracoscopic anterior release combined with a posterior spinal fusion for juvenile idiopathic scoliosis, unilateral loss of neuromonitoring signals was noted during the posterior instrumentation, and epidural pneumorrhachis was identified by intraoperative O-arm imaging. An immediate laminectomy and decompression of epidural fat and air were performed, resulting in return of the neuromonitoring signals. The patient had no clinical motor or neurological deficits postoperatively, and the posterior spinal fusion was completed successfully 3 days later.
Conclusion: Epidural pneumorrhachis is a possible complication of scoliosis surgery with pedicle screw fixation, which can result in the intraoperative loss of neuromonitoring signals; however, rapid identification and intervention can result in an excellent outcome.