Recurrent Pneumothorax Following Multilevel Posterior Spinal Fixation in a Patient With Pre‐Existing Pulmonary Contusion: A Case Report

ABSTRACT

Recurrent pneumothorax following posterior spinal fixation is a rare but life‐threatening complication, particularly in polytrauma patients with underlying pulmonary contusion. We report a 19‐year‐old male involved in a high‐speed maritime accident who sustained a T12 fracture and right‐sided pulmonary contusion. Initial pneumothorax was managed with a chest tube, which was removed after radiographic resolution. Subsequently, the patient underwent posterior T10–L2 fixation. Immediately postoperatively, he developed acute dyspnea and massive recurrent pneumothorax requiring urgent re‐intervention. Despite limited initial imaging data due to his foreign national status, the patient recovered fully following tertiary care referral. This case illustrates that radiographic lung re‐expansion is an insufficient criterion for chest tube removal before spinal surgery. The physiological stress of prone positioning and positive pressure ventilation can reactivate occult air leaks in contused lungs. We recommend retaining chest tubes until after spinal fixation to prevent catastrophic recurrence.