Lim Jea Woo, Sharma Veushj, Kim Hak Sun
Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Asian Spine J. 2012 Jun;6(2):140-4. doi: 10.4184/asj.2012.6.2.140. Epub 2012 May 31.
A 13-year-9-month-old female child presented with congenital kyphoscoliosis along with progressive paraparesis. Radiographs confirmed kyphoscoliosis and magnetic resonance imaging revealed a stretched and flattened spinal cord over the kyphotic deformity and a T7 hemivertebra. She underwent a posterior correction of the curve along with posterior decompression and a posterior to anterior excision of T7 hemivertebra to relieve her of the deteriorating neurology. While carrying out the excision of T7 hemivertebra, her trans cranial electrical motor evoke potential dropped. Consequently, she was administered a mega dose steroid therapy. After a positive wake-up test, the excision was discontinued and surgery was concluded by in situ fixation of the deformity with short rods. Thereafter, a gradual deterioration in the neurologic status was observed and patient became paraplegic on the fourth post operative day. In this case report, we try to analyze various causes for gradual deterioration in neurologic status.
一名13岁9个月大的女童患有先天性脊柱后凸侧弯并伴有进行性双下肢轻瘫。X线片证实了脊柱后凸侧弯，磁共振成像显示在脊柱后凸畸形处脊髓被拉长且扁平，以及一个T7半椎体。她接受了后路脊柱侧弯矫正术、后路减压术以及T7半椎体的后前路切除术，以缓解其不断恶化的神经功能障碍。在进行T7半椎体切除时，她的经颅电运动诱发电位下降。因此，对她进行了大剂量类固醇治疗。在唤醒试验呈阳性后，停止了切除手术，并通过短棒原位固定畸形完成了手术。此后，观察到神经功能状态逐渐恶化，患者在术后第四天出现截瘫。在本病例报告中，我们试图分析神经功能状态逐渐恶化的各种原因。
