Hubbard Molly E, Hunt Matthew A, Jones Kristen E, Polly David W
Departments of1Neurosurgery and.
2Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota.
J Neurosurg Spine. 2017 Dec;27(6):638-642. doi: 10.3171/2017.5.SPINE161243. Epub 2017 Sep 8.
Congenital scoliosis due to a hemivertebra requires surgical stabilization prior to skeletal maturity if rapidly progressive curve growth occurs. Here the authors present the unique case of a man who, at the age of 12 years, had undergone Harrington rod placement for stabilization of progressive congenital scoliosis due to a T-11 hemivertebra and then, at the age of 53 years, presented with acutely progressive myelopathy due to spinal cord compression from an arachnoid web at T-11 despite a solid fusion mass at the prior surgical site. The patient underwent a posterior midline approach for resection of the T-11 pedicle at the level of the hemivertebra, intradural spinal cord detethering with resection of the arachnoid web at T-11, and T2-L2 instrumented fusion with deformity correction, leading to subsequent resolution of his acute myelopathic symptoms. In conclusion, arachnoid web formation superimposed on preexisting tension on the thoracic spinal cord from congenital scoliosis due to a T-11 hemivertebra caused acute myelopathy in an adult with a previously solid fusion mass from childhood. The resolution of acute myelopathy and halting of further progression occurred with pedicle resection, arachnoid web fenestration, and spinal deformity correction.
如果由于半椎体导致的先天性脊柱侧弯出现快速进展的曲线生长，则需要在骨骼成熟前进行手术固定。本文作者介绍了一个独特的病例，一名男性在12岁时因T11半椎体导致的进行性先天性脊柱侧弯接受了哈灵顿棒置入术以进行固定，然后在53岁时，尽管先前手术部位有坚实的融合块，但因T11处蛛网膜网压迫脊髓而出现急性进行性脊髓病。患者接受了后正中入路，在半椎体水平切除T11椎弓根，在T11处切除蛛网膜网进行硬膜内脊髓松解，并进行T2-L2器械固定融合及畸形矫正，随后其急性脊髓病症状得到缓解。总之，T11半椎体导致的先天性脊柱侧弯使胸段脊髓预先存在张力，在此基础上叠加蛛网膜网形成，导致一名成年患者出现急性脊髓病，该患者儿童时期曾有坚实的融合块。椎弓根切除、蛛网膜网开窗和脊柱畸形矫正使急性脊髓病得到缓解并阻止了进一步进展。
