Session Time: 11:15am-12:45pm
Location: Research Hub - Kiosk 6
Disclosures: Nicole L. Pontee, MD, MS: Nothing to disclose
Case Description: The patient underwent L5-S2 laminectomy on 8/7/2018 then T2-pelvis posterior spinal fusion with Neurosurgery and Orthopedic Surgery. She was fitted with an LSO brace for ambulation and was discharged to acute inpatient rehab on 9/12/2018. By the date of discharge, she could ambulate 50 ft without assistive devices with steady gait. She was discharged home on 9/25/2018. On 11/28/2018, V.O came to the ED with dyspnea and pleuritic chest pain for 3 days. Chest CT angiogram revealed left lower lobe segmental pulmonary emboli.
Setting: Acute inpatient rehabilitation
Patient: V.O. is a 25-year-old Guyanese woman with dysmorphic scoliosis from neurofibromatosis type 1 (NF1) resulting in severe coronal and sagittal imbalance limiting ADLs.
Assessment/Results: Pulmonary embolism was identified on CT angiogram imaging of the pulmonary arteries 3 months post-operatively. She was placed on therapeutic low molecular weight heparin and transitioned to Apixaban for anticoagulation of delayed post-operative complication of venous thromboembolism several months after surgical intervention.
Discussion: Neurofibromatosis is a rare autosomal dominant disease process that to date has not been linked to hypercoagulability, but is associated with vascular abnormalities like aneurysmal formation, stenosis, and vessel rupture that can to thrombosis and ischemia. Spinal fusion surgeries are associated with venothromboembolic complications typically up to 30 days post-operatively. This case demonstrates a delayed post-operative complication of pulmonary embolism in a patient with neurofibromatosis with dysmorphic scoliosis 3 months post-operatively.
Conclusion: Patients with neurofibromatosis type 1 with scoliosis undergoing corrective spine surgery may be at higher risk for development of VTE complications months after surgery.
Level of Evidence: Level V
To cite this abstract in AMA style:Pontee NL, Sitapara KA, Jouvin-Castro MA. Delayed Onset Pulmonary Embolism in a Patient with Neurofibromatosis with Dysmorphic Scoliosis After Laminectomy and Spinal Fusion [abstract]. PM R. 2019; 11(S2)(suppl 2). https://pmrjabstracts.org/abstract/delayed-onset-pulmonary-embolism-in-a-patient-with-neurofibromatosis-with-dysmorphic-scoliosis-after-laminectomy-and-spinal-fusion/. Accessed December 3, 2023.
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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/delayed-onset-pulmonary-embolism-in-a-patient-with-neurofibromatosis-with-dysmorphic-scoliosis-after-laminectomy-and-spinal-fusion/