Tatara Yasunori, Kawakami Noriaki, Tsuji Taichi, Miyasaka Kazuyoshi, Ohara Tetsuya, Nohara Ayato
Meijo Hospital, Spine Center, Nagoya, Aichi, Japan.
Scoliosis. 2011 Sep 30;6:21. doi: 10.1186/1748-7161-6-21.
Case report.
The authors present the case of a 14-year-old boy with Rubinstein-Taybi syndrome (RSTS) presenting scoliosis.
There have been no reports on surgery for RSTS presenting scoliosis.
The patient was referred to our hospital for evaluation of a progressive spinal curvature. A standing anteroposterior spine radiograph at presentation to our hospital revealed an 84-degree right thoracic curve from T6 to T12, along with a 63-degree left lumbar compensatory curve from T12 to L4. We planned a two-staged surgery and decided to fuse from T4 to L4. The first operation was front-back surgery because of the rigidity of the right thoracic curve. The second operation of lumbar anterior discectomy and fusion was arranged 9 months after the first surgery to prevent the crankshaft phenomenon due to his natural course of adolescent growth. To avoid respiratory complications, the patient was put on a respirator in the ICU for several days after both surgeries.
Full-length spine radiographs after the first surgery revealed no instrumentation failure and showed that the right thoracic curve was corrected to 31 degrees and the left lumbar curve was corrected to 34 degrees. No postoperative complications occurred after both surgeries.
We succeeded in treating the patient without complications. Full-length spine standing radiographs at one year after the second operation demonstrated a stable bony arthrodesis with no loss of initial correction.
病例报告。
作者报告一例患有鲁宾斯坦-泰比综合征(RSTS)并伴有脊柱侧弯的14岁男孩的病例。
尚无关于RSTS伴脊柱侧弯手术治疗的报道。
该患者因进行性脊柱侧弯被转诊至我院。我院接诊时的脊柱站立位前后位X线片显示,从T6至T12有一个84度的右胸弯,以及从T12至L4有一个63度的左腰代偿弯。我们计划进行两阶段手术,并决定从T4至L4进行融合。由于右胸弯僵硬,第一次手术采用前后联合手术。第一次手术后9个月安排了第二次手术,即腰椎前路椎间盘切除融合术,以防止因青少年自然生长过程导致的曲轴现象。为避免呼吸并发症,两次手术后患者均在重症监护病房使用呼吸机数天。
第一次手术后的全长脊柱X线片显示无内固定失败,右胸弯矫正至31度,左腰弯矫正至34度。两次手术后均未发生术后并发症。
我们成功治疗了该患者且无并发症。第二次手术后一年的脊柱全长站立位X线片显示有稳定的骨融合,初始矫正无丢失。