Bourghli Anouar, Abduljawad Salim M, Boissiere Louis, Obeid Ibrahim
Orthopedic and Spinal Surgery Department, Kingdom Hospital, P.O.Box 84400, Riyadh, 11671, Saudi Arabia.
Orthopedic Spinal Surgery Unit 1, Bordeaux Pellegrin Hospital, Bordeaux, France.
Spine Deform. 2020 Aug;8(4):819-827. doi: 10.1007/s43390-020-00050-3. Epub 2020 Feb 5.
Case report.
To describe a rare case of thoracolumbar kyphoscoliosis secondary to a butterfly vertebra in an adult, and its surgical correction technique.
Kyphoscoliosis secondary to an isolated butterfly vertebra is rare and its management can be very challenging.
We report the case of a 39-year-old male, complaining of chronic middle and low back pain with unsteady gait and altered sensation of lower extremities. Full spine anteroposterior and lateral X-rays revealed a thoracolumbar kyphosis with an angulation of 60° between T10 and T12, with a short thoracolumbar scoliosis of 32 degrees. CT scan confirmed the presence of a butterfly vertebra at the level of T11 with posterior arch fusion between T10 and T12. MRI showed cord compression at the apex of the kyphosis associated to syringomyelia.
The patient underwent a posterior resection of the T11 butterfly vertebra with instrumentation from T8 to L2, and use of a one-sided domino on the convex side and a mesh cage on the concave side for asymmetrical correction and vertebral height preservation. Thoracolumbar kyphosis was corrected to 10°. Scoliosis was corrected to 6°. He could walk on day 2 with a satisfactory clinical and radiological result at 2 years.
Literature is sparse on the management of thoracolumbar kyphoscoliosis secondary to butterfly vertebra in the context of neurological impairment. The current case described a surgical treatment strategy to correct both deformity planes simultaneously by a vertebral resection performed through a posterior only approach.
病例报告。
描述一例成人因蝴蝶椎导致胸腰段脊柱后凸侧弯的罕见病例及其手术矫正技术。
孤立性蝴蝶椎继发的脊柱后凸侧弯罕见，其治疗极具挑战性。
我们报告了一例39岁男性患者，主诉慢性中低位腰痛、步态不稳及下肢感觉改变。全脊柱正侧位X线片显示胸腰段脊柱后凸，T10与T12之间成角60°，伴有32度的短节段胸腰段脊柱侧弯。CT扫描证实T11水平存在蝴蝶椎，T10与T12之间有后弓融合。MRI显示后凸顶点处脊髓受压并伴有脊髓空洞症。
患者接受了T11蝴蝶椎后路切除术，从T8至L2进行内固定，凸侧使用单侧多米诺骨牌，凹侧使用网笼进行不对称矫正并保留椎体高度。胸腰段脊柱后凸矫正至10°。脊柱侧弯矫正至6°。术后第2天患者即可行走，2年时临床和影像学结果均令人满意。
关于神经功能受损情况下蝴蝶椎继发胸腰段脊柱后凸侧弯的治疗，文献报道较少。本病例描述了一种仅通过后路椎体切除术同时矫正两个畸形平面的手术治疗策略。
