Mousavi Seyed Reza, Farrokhi Majid Reza, Liaghat Alireza, Hassani Amirhossein, Kazeminezhad Ali, Ghaffarpasand Fariborz
Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran.
Shiraz Neurosciences Research Center, Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran.
Int J Surg Case Rep. 2023 Aug;109:108618. doi: 10.1016/j.ijscr.2023.108618. Epub 2023 Aug 4.
Scheuermann's kyphosis is a structural deformity of the thoracolumbar spine that is classified in typical (thoracic) and atypical (lumbar and thoracolumbar) Scheuermann's disease. Surgical intervention is reserved for those with progressive kyphosis, intractable pain and neurological impairment. Although, previous literature focuses on the correction of the thoracic kyphosis (TK), recent lines of evidence recommend considering all the sagittal balance parameters when performing a surgery. We herein, report a posterior-only approach in a patient with Scheuermann's kyphosis, considering all the sagittal balance parameters.
The patient was a 17-year-old boy with a kyphotic deformity in the lumbar region, with urinary retention and upper back intractable pain. The preoperative physical examination was normal except for a kyphotic gait. The patient was first treated with thoracic lumbosacral orthoses (TLSO) brace that was not effective; consequently, the patient underwent posterior only approach (pedicular screw fixation along with Smith-Peterson osteotomy) with correction of the sagittal balance and kyphosis. The patient's sign and symptoms improved significantly. The surgery was uneventful and no complication was recorded. The 1-year follow-up revealed normal neurological examination and normal sagittal balance parameters.
Atypical Scheuermann's kyphosis with neurological impairment and progressive kyphosis should be treated with surgical intervention.
Considering the sagittal parameters of the spine, the surgical intervention should be designed to correct the kyphosis and the other indices of the sagittal balance. Posterior-only approach is safe and effective method for correction of the TK and improving the signs and symptoms of the patients.
休曼氏后凸是胸腰椎的一种结构性畸形，分为典型（胸椎）和非典型（腰椎及胸腰段）休曼氏病。手术干预适用于进行性后凸、顽固性疼痛和神经功能障碍患者。尽管既往文献主要关注胸椎后凸（TK）的矫正，但最近的证据表明，手术时应考虑所有矢状面平衡参数。在此，我们报告一例采用单纯后路手术治疗休曼氏后凸患者的病例，术中考虑了所有矢状面平衡参数。
患者为一名17岁男孩，腰椎有后凸畸形，伴有尿潴留和上背部顽固性疼痛。除后凸步态外，术前体格检查正常。患者最初接受胸腰骶矫形器（TLSO）支具治疗，效果不佳；因此，患者接受了单纯后路手术（椎弓根螺钉固定联合史密斯-彼得森截骨术），以矫正矢状面平衡和后凸。患者的体征和症状明显改善。手术过程顺利，未记录到并发症。1年随访显示神经检查正常，矢状面平衡参数正常。
伴有神经功能障碍和进行性后凸的非典型休曼氏后凸应采用手术干预治疗。
考虑到脊柱的矢状面参数，手术干预应旨在矫正后凸及矢状面平衡的其他指标。单纯后路手术是矫正TK及改善患者体征和症状的安全有效方法。
