青少年特发性脊柱侧凸后路胸腰段脊柱融合内固定术后四肢瘫痪延迟出现。
Delayed presentation of tetraparesis following posterior thoracolumbar spinal fusion and instrumentation for adolescent idiopathic scoliosis.
机构信息
Department of Orthopaedic Surgery, University of California, San Francisco, CA 94143, USA.
出版信息
Spine (Phila Pa 1976). 2009 Dec 1;34(25):E936-41. doi: 10.1097/BRS.0b013e3181b2e04f.
STUDY DESIGN
Case report.
OBJECTIVE
We present a case of delayed tetraparesis in a patient after posterior spinal fusion for adolescent idiopathic scoliosis.
SUMMARY OF BACKGROUND DATA
The reported rate of neural complications after scoliosis surgery is low. Intraoperative neuromonitoring is used to detect and prevent spinal cord injury.
METHODS
Review of medical record.
RESULTS
Delayed tetraparesis developed on the second postoperative day after unremarkable T3-L4 posterior fusion. MRI revealed evidence of cord ischemia at C4-C7. Angiogram revealed a hypervascular T4 body resulting in arteriovenous shunting into the epidural venous plexus.
CONCLUSION
Venous congestive myelopathy due to arteriovenous shunting or unrecognized syrinx are presented as possible etiologies of this patient's spinal cord injury. A preoperative MRI may have helped discern the cause of this patient's spinal cord injury.
研究设计
病例报告。
目的
我们报告了一例青少年特发性脊柱侧凸后路脊柱融合术后出现迟发性四肢瘫痪的病例。
背景资料摘要
脊柱侧凸手术后神经并发症的报告发生率较低。术中神经监测用于检测和预防脊髓损伤。
方法
回顾病历。
结果
术后第二天出现 T3-L4 后路融合后无明显异常的四肢瘫痪。MRI 显示 C4-C7 处脊髓缺血的证据。血管造影显示 T4 椎体呈高血管性，导致动静脉分流至硬膜外静脉丛。
结论
静脉充血性脊髓病由于动静脉分流或未被识别的脊髓空洞症，可能是该患者脊髓损伤的病因。术前 MRI 可能有助于确定该患者脊髓损伤的原因。
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