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The complaint was reviewed and a postoperative radiograph was evaluated.Imaging confirmed the presence of a posterior spinal construct with bilateral pedicle screws and rods.On the patient's right side, a visible lateral offset was noted between the rod and tulip heads, most prominently at the l1 level.This radiographic finding is consistent with intraoperative reports of alignment and reduction challenges.It is possible that misalignment during rod reduction contributed to cross-threading or incomplete engagement of the set screws.However, the root cause cannot be definitively determined as the implants were not returned for evaluation.The issues were resolved intraoperatively through the use of alternate instrumentation and rod manipulation techniques.There was no report of device breakage, patient injury, or need for revision surgery.However, prolonged intraoperative manipulation resulted in an approximate 30-minute surgical delay, prompting this report.Review of labeling: possible adverse events like other spinal system implants, the following adverse events are possible.This list is not exhaustive: delayed union or nonunion (pseudarthrosis) bending, disassembly, or fracture of implant and components loosening of spinal fixation implants may occur due to inadequate initial fixation, latent infection, and/or premature loading, possibly resulting in bone erosion, migration, or pain pain, discomfort, or abnormal sensations due to the presence of the device pressure on skin where inadequate tissue coverage exists over the implant, with potential extrusion through the skin dural leak requiring surgical repair cessation of growth of the fused portion of the spine subsidence of the implant into adjacent bone loss of proper spinal curvature, correction, height, and/or reduction increased biomechanical stress on adjacent levels improper surgical placement of the implant causing stress shielding of the graft or fusion mass intraoperative fracture or perforation of the spine postoperative fracture due to trauma, defects, or poor bone stock serious complications associated with any surgery may occur.These include, but are not limited to: wound complications, infection, genitourinary disorders, gastrointestinal disorders, respiratory disorders; cardiovascular disorders, including myocardial infarction (heart attack) or arrythmias; neurologic injuries resulting in weakness, paralysis, numbness, tingling, or pain; vascular (blood vessel) injuries, including hemorrhage (bleeding); thrombosis (blood clots) leading to deep venous thrombosis or pulmonary embolism; or death.
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