Shigematsu Hideki, Koizumi Munehisa, Iida Jin, Iwata Eiichiro, Tanaka Yasuhito
Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, 6348522, Japan,
Eur Spine J. 2014 May;23 Suppl 2:278-84. doi: 10.1007/s00586-014-3298-7. Epub 2014 Apr 11.
Pedicle subtraction osteotomy (PSO) was developed to achieve significant correction of a deformity. It was initially used to correct sagittal plane deformities associated with ankylosing spondylitis, but recently it has also been performed in patients with post-traumatic kyphosis. Our aim was to report a case of a floating spine after PSO for post-traumatic kyphosis.
A 50-year-old man was injured after a fall. He had a compression fracture at T12 and an open fracture of the right lower limb. Although he presented with focal back pain, his open fracture was treated first by surgical intervention. The T12 compression fracture was treated conservatively. One year later, he had lower limb numbness and muscle weakness. His imaging demonstrated focal kyphosis on T12 and spinal cord compression. The diagnosis was post-traumatic kyphosis, which was treated with PSO. We performed osteotomy at T12, discectomy and bone graft at T11-T12, and posterior fusion from T10 to L2.
One year after PSO, we removed the instruments because he complained of pain around them and found complete bony union between T11 and T12. He immediately experienced worse pain and could not walk or stand for more than 10 min. Imaging showed a floating spine between T12 and L1. He underwent anterior fusion at T12-L1, after which his severe back pain disappeared.
This case points out a pitfall of PSO. Although it is a powerful tool for correcting an imbalanced spine, we should recognize its pitfalls and try to avoid them.
椎弓根截骨术（PSO）旨在实现对畸形的显著矫正。它最初用于矫正与强直性脊柱炎相关的矢状面畸形，但最近也应用于创伤后驼背患者。我们的目的是报告1例创伤后驼背行PSO术后出现脊柱漂浮的病例。
一名50岁男性在跌倒后受伤。他在T12处有压缩性骨折，右下肢开放性骨折。尽管他有局部背痛，但他的开放性骨折首先通过手术干预进行治疗。T12压缩性骨折采用保守治疗。1年后，他出现下肢麻木和肌肉无力。影像学检查显示T12处有局部驼背和脊髓受压。诊断为创伤后驼背，采用PSO治疗。我们在T12处进行截骨，在T11 - T12处行椎间盘切除术和植骨，并进行了从T10到L2的后路融合。
PSO术后1年，由于他抱怨内固定周围疼痛，我们取出了内固定装置，发现T11和T12之间有完全的骨融合。他立即感到疼痛加剧，无法行走或站立超过10分钟。影像学检查显示T12和L1之间存在脊柱漂浮。他接受了T12 - L1前路融合术，术后严重的背痛消失。
本病例指出了PSO的一个陷阱。尽管它是矫正脊柱失衡的有力工具，但我们应该认识到其陷阱并尽量避免。
