Tribus C B
University of Wisconsin Hospital and Clinics, Madison, Wisconsin, USA.
Spine (Phila Pa 1976). 2001 May 1;26(9):1086-9. doi: 10.1097/00007632-200105010-00021.
Transient paraparesis during the operative management of a 16-year-old patient with Scheuermann's kyphosis secondary to thoracic stenosis is reported.
To describe a treatable cause for paraparesis in a patient with Scheuermann's kyphosis undergoing surgical treatment.
Cord injury in the surgical treatment of Scheuermann's kyphosis is a rare event, yet it is felt to be more common in the surgical correction of kyphosis than in surgery for scoliosis. Suggested etiologies have included vascular insufficiency, hypotension, direct mechanical trauma, and neural element stretch. Concomitant thoracic spinal stenosis predisposing to neurologic injury during surgical manipulation has not been reported.
A 16-year-old boy with progressive Scheuermann's kyphosis measuring 80 degrees from T7 to T12 underwent an anteroposterior spinal fusion with somatosensory-evoked potential monitoring and wake-up tests. During the instrumentation posteriorly, somatosensory-evoked potential monitoring became markedly abnormal. This was followed by a wake-up test that demonstrated the patient's inability to move either of his lower extremities. All instrumentation was removed. The patient had recovered neurologic function by the time he reached the recovery room. A computed tomography myelogram was performed on the third postoperative day, which demonstrated severe thoracic stenosis from T8 to T10. The patient was returned to the operating room 1 week later to undergo a posterior laminectomy from T7 to T11 and instrumented fusion from T5 to L2. Somatosensory-evoked potential monitoring was stable throughout this procedure, and the wake-up test was normal.
The patient's postoperative course and subsequent 2-year follow-up period were unremarkable. He progressed to clinical and radiographic union and maintained a normal lower extremity neurologic examination.
A treatable cause for paraparesis secondary to the surgical treatment of Scheuermann's kyphosis is presented. The author currently obtains a thoracic magnetic resonance image (MRI) before the surgical correction of any patients with Scheuermann's kyphosis.
报道了一名16岁患有继发于胸椎狭窄的休门氏后凸畸形患者在手术治疗过程中出现短暂性截瘫的情况。
描述在接受手术治疗的休门氏后凸畸形患者中截瘫的一个可治疗原因。
休门氏后凸畸形手术治疗中的脊髓损伤是一种罕见事件，但人们认为其在脊柱后凸畸形的手术矫正中比在脊柱侧凸手术中更常见。推测的病因包括血管供血不足、低血压、直接机械创伤和神经元件拉伸。尚未有关于手术操作过程中伴有胸椎椎管狭窄易导致神经损伤的报道。
一名16岁男孩，患有从T7至T12进展性休门氏后凸畸形，角度为80度，接受了前后路脊柱融合术，并进行体感诱发电位监测和唤醒试验。在后方器械置入过程中，体感诱发电位监测明显异常。随后进行的唤醒试验表明患者双下肢均无法活动。所有器械均被移除。患者到达恢复室时已恢复神经功能。术后第三天进行了计算机断层扫描脊髓造影，显示T8至T10严重胸椎狭窄。1周后患者返回手术室，接受T7至T11后路椎板切除术以及T5至L2器械融合术。在此过程中，体感诱发电位监测一直稳定，唤醒试验正常。
患者术后病程及随后的2年随访期间均无异常。他实现了临床和影像学融合，下肢神经检查保持正常。
提出了休门氏后凸畸形手术治疗继发截瘫的一个可治疗原因。作者目前在对任何休门氏后凸畸形患者进行手术矫正前都会获取胸椎磁共振成像（MRI）。
