Ajavon L, Amelot A, Conso C, Balabaud L, Mazel C
Department of Orthopaedics Surgery, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014 Paris, France.
Department of Orthopaedics Surgery, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014 Paris, France.
Spine J. 2016 Jan 1;16(1):117-22. doi: 10.1016/j.spinee.2015.09.041. Epub 2015 Sep 28.
Rapidly progressing extrinsic spinal cord compression syndromes are rare, especially when the compression is associated with the supine position.
This work presents a case of extrinsic thoracic spinal cord compression related to the supine position and describes our approach from diagnosis to the technical therapeutic creation of a spinal protection shield.
One case of a patient suffering from extrinsic spinal cord compression syndrome is reported.
We report the case of a Coptic priest patient who, as a result of Pott disease sequelae, underwent several decompressive and stabilizing surgeries for major kyphoscoliosis. Consequently, he developed extrinsic thoracic spinal cord compression caused by the supine position.
After each instrumentation device removal, we noticed progressive severe paraparesis when the patient was supine. Imaging assessment confirmed spinal dynamic and intermittent compressions triggered by the supine position, which was facilitated by the exposure and vulnerability of the thoracic spine cord.
We implanted a tailored titanium mesh spinal protection shield and a trapezius flap for spine coverage. This work presents the diagnostic aspects as well as several surgical technique options.
At the 6-year follow-up, the patient's neurologic conditions were significantly improved. We report neurologic improvements, no sphincter disorder, persistent spasticity, and lower limbs weakness not affecting full ambulation.
To our knowledge, no other case of spinal protection shield in compressions caused by the supine position have been studied. The surgical and technical management therefore remains innovative.
快速进展的外在性脊髓压迫综合征较为罕见，尤其是当压迫与仰卧位相关时。
本文介绍一例与仰卧位相关的外在性胸段脊髓压迫病例，并描述我们从诊断到技术治疗创建脊髓保护罩的方法。
报告一例患有外在性脊髓压迫综合征患者的病例。
我们报告一例科普特牧师患者的病例，该患者因脊柱结核后遗症，接受了多次针对严重脊柱侧弯的减压和稳定手术。结果，他因仰卧位出现了外在性胸段脊髓压迫。
每次取出内固定装置后，我们注意到患者仰卧时会出现进行性严重下肢轻瘫。影像学评估证实了仰卧位引发的脊髓动态和间歇性压迫，胸椎脊髓的暴露和易损性促进了这种压迫。
我们植入了定制的钛网脊髓保护罩和用于覆盖脊柱的斜方肌皮瓣。本文介绍了诊断方面以及几种手术技术选择。
在6年的随访中，患者的神经状况有显著改善。我们报告了神经功能的改善，无括约肌障碍、持续性痉挛，下肢无力不影响完全行走。
据我们所知，尚未有其他关于仰卧位引起的压迫中使用脊髓保护罩的病例研究。因此，手术和技术管理仍然具有创新性。
