The Daniel and Jane Och Spine Hospital, New York Presbyterian/Columbia University Medical Center, New York, New York, USA.
Department of Neurosurgery, USA Health, Mobile, Alabama, USA.
Oper Neurosurg (Hagerstown). 2021 Jul 15;21(2):E129-E135. doi: 10.1093/ons/opab085.
Lumbar hyperlordosis in ambulatory children is an uncommon but potentially problematic spinal deformity, and the operative management has not been comprehensively described.
We report the case of a 14-yr-old girl presenting with severe progressive lumbar hyperlordosis (-122°) and sagittal imbalance (-6 cm). She had multiple prior surgeries, including myelomeningocele repair at 10 d old, midlumbar meningioma resection at 8 mo old, and posterior lumbar instrumented spinal fusion at 5 yr old. She presented with progressive lumbosacral back pain and intermittent numbness in her left lower extremity, and severe skin contractures over her prior posterior incisions. From an all posterior approach, prior implants and dural scar were removed and then an L5 vertebral column resection (VCR) was performed to disarticulate her lumbar spine from her anteverted pelvis, allowing for slow distraction forces to correct her lumbar hyperlordosis. This was followed by a T7-sacrum fusion using pedicle screws and iliac screws, with autologous bone graft and plastic surgery wound closure. Postoperatively, lumbar lordosis was corrected to -55° and sagittal balance reduced to -0.5 cm. At 10-wk and 14-mo follow-ups, the patient reported resolution of her back pain with no limitations in physical activities. Dramatic improvement was seen in both her preoperative to 14-mo postoperative Oswestry Disability Index (ODI) (54 to 12) and Scoliosis Research Society Scoliosis Research Society (SRS)-22r (54 to 93) scores.
This case highlights a rare presentation of severe progressive lumbar hyperlordosis in an ambulatory adolescent after myelomeningocele repair, meningioma resection, and posterior lumbar instrumented spinal fusion with subsequent surgical treatment incorporating important components of both spinal and plastic surgery involvement.
在能行走的儿童中，腰椎过度前凸是一种不常见但可能有问题的脊柱畸形，其手术治疗尚未得到全面描述。
我们报告了一例 14 岁女孩的病例，她表现为严重的进行性腰椎过度前凸（-122°）和矢状面失衡（-6cm）。她曾多次接受手术，包括出生后 10 天的脊髓脊膜膨出修补术、8 个月大的中腰椎脑膜瘤切除术和 5 岁时的后路腰椎器械性脊柱融合术。她出现进行性腰骶背痛和左下肢间歇性麻木，并伴有先前后路切口的严重皮肤挛缩。采用全后路入路，切除先前的植入物和硬脊膜瘢痕，然后进行 L5 椎体切除术（VCR），使腰椎与前旋骨盆脱开，允许缓慢的牵开力来矫正腰椎过度前凸。接着进行 T7-骶骨融合，使用椎弓根螺钉和髂骨螺钉，自体骨移植和整形手术闭合伤口。术后腰椎前凸矫正至-55°，矢状面平衡减少至-0.5cm。在 10 周和 14 个月的随访中，患者报告背痛缓解，体力活动无受限。术前到 14 个月的 Oswestry 残疾指数（ODI）（54 分至 12 分）和脊柱侧凸研究协会脊柱侧凸研究协会（SRS）-22r 评分（54 分至 93 分）都有显著改善。
本例突出了脊髓脊膜膨出修补术、脑膜瘤切除术和后路腰椎器械性脊柱融合术后能行走的青少年中罕见的严重进行性腰椎过度前凸的表现，随后的手术治疗包含了脊柱和整形手术的重要内容。
