Nakashima Hiroaki, Yukawa Yasutsugu, Ito Keigo, Machino Masaaki, Kanbara Shunsuke, Morita Daigo, Imagama Shiro, Ishiguro Naoki, Kato Fumihiko
Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Orthopedic Surgery, Chubu Rosai Hospital, Nagoya, Japan.
Nagoya J Med Sci. 2015 Feb;77(1-2):315-20.
We experienced the rare complication of a vertebral fracture that was caused by implant removal after bony fusion had been achieved in a patient who underwent spine-shortening osteotomy (SSO) for tethered cord syndrome (TCS). We propose that the removal of the implant used for SSO should be contraindicated. The patient (a 27-year-old female) presented to our institution with a history of progressive severe lower back pain, gait disturbance, and urinary incontinence. As an infant, she had undergone surgery for spina bifida with lipoma. Magnetic resonance imaging of the spine revealed tethering of the spinal cord to a lipoma. We performed SSO at the level of the L1 vertebra level. After spine shortening and fixation using a posterior approach, the L1 vertebral body was completely removed anteriorly and replaced with a left iliac bone graft. The patient's symptoms improved after surgery. After bony fusion was achieved after surgery, we decided to remove the spinal implant after we explained the advantages and disadvantages of the procedure to the patient. We performed implant removal surgery safely 2 years later; however, the patient complained of severe lower back pain 10 days after the surgery without any history of trauma. Reconstruction computed tomography showed fracture of the grafted vertebra. We performed a repeat posterior fixation, which relieved the lower back pain; she has experienced no complications in the subsequent 5 years. In summary, we report a case of a rare complication of the fracture of a grafted vertebra after removal of an implant used in SSO for TCS. Spinal stability could not be maintained without the spinal posterior implant after SSO. Postoperative fracture after spinal implant removal is rare but possible, and patients must be informed of this potential risk.
我们遇到了一例罕见的并发症，一名因脊髓拴系综合征（TCS）接受脊柱缩短截骨术（SSO）的患者在实现骨融合后因取出植入物而导致椎体骨折。我们建议禁忌取出用于SSO的植入物。该患者（一名27岁女性）因进行性严重下背部疼痛、步态障碍和尿失禁病史前来我院就诊。婴儿期，她曾接受脊柱裂伴脂肪瘤手术。脊柱磁共振成像显示脊髓与脂肪瘤相连。我们在L1椎体水平进行了SSO。采用后路进行脊柱缩短和固定后，前方完全切除L1椎体，并用左髂骨移植替代。术后患者症状改善。术后实现骨融合后，在向患者解释了该手术的利弊后，我们决定取出脊柱植入物。两年后我们安全地进行了植入物取出手术；然而，患者在术后10天抱怨严重下背部疼痛，无任何外伤史。重建计算机断层扫描显示移植椎体骨折。我们再次进行了后路固定，缓解了下背部疼痛；在随后的5年里她没有出现任何并发症。总之，我们报告了一例因取出用于TCS的SSO植入物后移植椎体骨折的罕见并发症病例。SSO后没有脊柱后路植入物则无法维持脊柱稳定性。脊柱植入物取出术后骨折虽罕见但有可能发生，必须告知患者这一潜在风险。
