Postoperative Paraplegia in Patient with Thoracic Ossification of Ligamentum Flavum and Thoracolumbar Kyphosis Derived from Wedged Vertebrae.

BACKGROUND

Thoracic ossification of the ligamentum flavum (OLF) is a common cause of thoracic myeloradiculopathy. Thoracolumbar kyphosis derived from abnormal embryonic development of the spine vertebrae often progresses continuously and causes neurologic deterioration. These conditions are presented separately in most cases. A diagnosis of both OLF and thoracolumbar kyphosis in the same patient is rare, and no definite principle of surgical strategy for this case could be found in the literature.

CASE DESCRIPTION

Here we report a 36-year-old woman who suffered from weakness and numbness of bilateral lower extremities for 2 years and urinary dysfunction for 1 month. On physical examination, the strength of muscles of lower limbs was grade 2 and the sensory system was bilaterally lost below the inguinal groove with numbness in the saddle area. Hyperreflexia was found in both lower limbs, and the Babinski sign was positive bilaterally. Thoracic OLF and thoracolumbar kyphosis were diagnosed on the basis of clinical presentation, radiograph, computed tomography, and magnetic resonance imaging. We performed 1-stage laminectomy and kyphosis correction by posterior vertebral column resection. The patient experienced postoperative paraplegia, and the strength of muscles of lower limbs recovered to the preoperative level at 1-year follow-up and stopped improving until the 5-year follow-up. However, the urinary dysfunction became normal at 3 months postoperative. Kyphotic deformity was corrected from preoperative 83.5 degrees to 35.0 degrees at the final follow-up, and bone fusion was achieved around the mesh cage without implantation failure.

CONCLUSIONS

For patients with thoracic OLF and thoracolumbar kyphosis derived from wedged vertebrae, 1-stage laminectomy and kyphosis correction has a risk that may lead to a negative outcome. Staging operation should be taken into consideration when planning a surgical strategy for the treatment of kyphosis associated with concurrent compressive myelopathy.