Spinal Cord Ischemia After Lower Extremity Surgery in Pediatric Osteogenesis Imperfecta With Thoracic Kyphoscoliosis: Tertiary Care Center Experience in Jeddah, Saudi Arabia

Osteogenesis imperfecta is a rare genetic disorder of type 1 collagen which primarily affects children and leads to recurrent bone fractures. In addition, spinal abnormalities can also occur. We report a case of a 13-year-old male with osteogenesis imperfecta type III, associated with severe femur deformity and thoracic kyphoscoliosis, who developed neurological injury after lower extremity surgery. The patient was in a supine position when general anesthesia was administered. The operation lasted for approximately 250 minutes, and anesthesia for 310 minutes, with an estimated blood loss of 600 cc. Apart from a low mean arterial pressure value (45 mm Hg) intraoperatively, the procedure was uneventful. Early postoperatively, he developed spinal paralysis at the level of T4-T7, and an MRI of the spine demonstrated high signal intensity within the spinal cord from level T3 to T7. Subsequently, he was admitted to the pediatric intensive care unit for further assessment and management. Follow-up revealed recovery of paralysis after 12 months.