Srivastava Sudhir, Marathe Nandan, Bhosale Sunil, Gautham Sai
Department of Orthopaedics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India.
Department of Orthopedics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India.
Asian J Neurosurg. 2019 Jul-Sep;14(3):1017-1020. doi: 10.4103/ajns.AJNS_52_19.
A 14-year-old boy presented with gradually worsening spastic quadriparesis and cervical kyphotic deformity as a consequence of laminectomy for tumor debulking and chemoradiotherapy done 2 years prior for cervical primitive neuroectodermal tumor. Problems to be addressed particularly to the case were a rigid kyphosis of 102.7°, poor soft-tissue coverage, internal gibbus compressing cord, perched facets, and superficial location of cord. The surgery was staged, in that the first anterior release was done with gradually increasing traction to correct the kyphosis progressively. Posterior instrumentation was done in the second stage. Finally, anterior reconstruction with tricortical iliac bone grafting was done. The patient regained full power with complete union at the end of 18 months. Irradiation of tumor along with laminectomy results in loss of posterior tension band which results in progressive kyphotic deformity in children. A staged plan of surgical interventions can help in postoperative correction of deformity with circumferential union and prevention of recurrence. This article describes successful treatment of a patient with postlaminectomy cervical kyphosis with 77° of correction achieved postoperatively and also highlights the importance of anterior and posterior reconstructions to achieve a stable vertebral column.
一名14岁男孩因两年前为治疗颈椎原始神经外胚层肿瘤而进行的肿瘤减瘤椎板切除术和放化疗，出现逐渐加重的痉挛性四肢瘫和颈椎后凸畸形。该病例需要特别解决的问题包括102.7°的僵硬后凸、软组织覆盖差、内部驼背压迫脊髓、关节突高位以及脊髓位置表浅。手术分阶段进行，首先进行前路松解，逐渐增加牵引以逐步矫正后凸。第二阶段进行后路内固定。最后，进行三皮质髂骨移植的前路重建。患者在18个月结束时恢复了全部肌力，实现了完全愈合。肿瘤放疗联合椎板切除术会导致后张力带丧失，从而导致儿童出现进行性后凸畸形。分阶段的手术干预计划有助于术后通过环形愈合矫正畸形并预防复发。本文描述了一名椎板切除术后颈椎后凸患者的成功治疗，术后实现了77°的矫正，同时强调了前后路重建对于实现稳定脊柱的重要性。
