Seki K, Shimizu K, Matsushita M, Li Z L, Niibayashi K, Yamamuro T
Department of Orthopaedic Surgery, Faculty of Medicine, Kyoto University.
No Shinkei Geka. 1994 May;22(5):481-4.
Postlaminectomy kyphosis is rarely encountered as a sequela of decompression of the upper cervical spine, especially in adults. We present a case of disabling cervical kyphosis which developed after laminectomy for excision of a foramen magnum tumor and was treated successfully by occipito-vertebral fusion. A sixty-one-year old female was treated by laminectomy of the first through to the third cervical spine for a foramen magnum meningioma. One year later, the laminectomy was extended downward to include the fourth through to the seventh cervical spine because of neurological deterioration. Seven years after the first laminectomy, she was referred to our spinal service because of severe neck pain, numbness and muscle weakness of both upper extremities. Lateral X-ray of her cervical spine presented a severe kyphosis. Roentgenogram two months after the first laminectomy already showed slight deformity and, timewise, it corresponded with the time when the patient experienced neurological deterioration. Subsequent X-rays showed progression of kyphosis. After we confirmed a lessening of the pain and improvement of the neurological symptoms during an axial traction using a halo-vest, posterior occipito-cervico-thoracic fusion was performed using Luque segmental spinal instrumentation and autogenous bone graft. After surgery the pain decreased and neurological symptoms improved. It is important to be aware of the complication of kyphotic deformity after laminectomy and once it has developed, it is recommended to stabilize the progression by early spinal fusion.
椎板切除术后脊柱后凸作为上颈椎减压的后遗症很少见，尤其是在成年人中。我们报告一例因枕骨大孔肿瘤行椎板切除术后发生的致残性颈椎后凸，并通过枕颈融合术成功治疗。一名61岁女性因枕骨大孔脑膜瘤接受了第一至第三颈椎的椎板切除术。一年后，由于神经功能恶化，椎板切除术向下延伸至包括第四至第七颈椎。首次椎板切除术后七年，她因严重颈部疼痛、麻木和双上肢肌肉无力被转诊至我们的脊柱科。她颈椎的侧位X线片显示严重后凸。首次椎板切除术后两个月的X线片已显示出轻微畸形，从时间上看，这与患者出现神经功能恶化的时间相符。随后的X线片显示后凸进展。在我们确认使用头环背心进行轴向牵引期间疼痛减轻且神经症状改善后，使用Luque节段性脊柱内固定和自体骨移植进行了后路枕颈胸融合术。手术后疼痛减轻，神经症状改善。认识到椎板切除术后脊柱后凸畸形的并发症很重要，一旦出现，建议通过早期脊柱融合来稳定病情进展。
