Keyoung H Michael, Kanter Adam S, Mummaneni Praveen V
Department of Neurological Surgery, University of California, San Francisco, California 94143, USA.
J Neurosurg Spine. 2008 Jan;8(1):74-9. doi: 10.3171/SPI-08/01/074.
There are many potential risks associated with spinal deformity correction procedures including transient and/or permanent neurological deficits. Typically, neurological deficits caused by the surgical correction of spinal kyphosis occur acutely during surgery or immediately after surgery. Delayed postoperative neurological deficits are extremely rare. The authors report a case of delayed neurological deficit that occurred 48 hours after surgical correction of thoracic hyperkyphosis. An 18-year-old man with myotonic dystrophy presented with a 110 degrees T7-L1 kyphosis. The patient underwent an uneventful two-stage correction procedure of the hyperkyphotic deformity. First, anterior discectomies and fusion were performed from T-7 to L-1 using rib autograft, and all segmental vessels were preserved. Subsequently, on the same day, the patient underwent posterior Smith-Petersen osteotomies and T7-L2 pedicle screw fixation. Intact somatosensory and motor evoked potentials were maintained throughout both operations. Postoperatively, he remained neurologically intact without sequelae for nearly 48 hours. On postoperative Day 2, the patient developed delayed monoplegia of the left leg and sensory level loss below T-10. Medical management enabled complete reversal of the patient's monoplegia and sensory loss. At 2-year follow-up, the patient had no adverse neurological sequelae. In this case, a delayed postoperative neurological deficit occurred following spinal hyperkyphosis correction. The authors discuss the possible etiological mechanisms behind this complication and suggest strategies for its management.
脊柱畸形矫正手术存在许多潜在风险，包括短暂性和/或永久性神经功能缺损。通常，脊柱后凸手术矫正引起的神经功能缺损在手术期间或手术后立即急性发生。术后延迟性神经功能缺损极为罕见。作者报告了一例胸椎后凸畸形手术矫正48小时后出现延迟性神经功能缺损的病例。一名患有强直性肌营养不良的18岁男性，存在110度的T7-L1后凸畸形。患者接受了一期顺利的两阶段后凸畸形矫正手术。首先，使用自体肋骨从T-7至L-1进行前路椎间盘切除术和融合术，所有节段血管均得以保留。随后，在同一天，患者接受了后路Smith-Petersen截骨术和T7-L2椎弓根螺钉固定术。在整个手术过程中，体感和运动诱发电位均保持完整。术后，他在近48小时内神经功能保持完好，无后遗症。术后第2天，患者出现左腿延迟性单瘫和T-10以下感觉平面丧失。药物治疗使患者的单瘫和感觉丧失完全恢复。在2年的随访中，患者无不良神经后遗症。在本病例中，脊柱后凸矫正术后出现了延迟性神经功能缺损。作者讨论了这一并发症背后可能的病因机制，并提出了其处理策略。
