Delayed-onset neurological deficit following correction of severe thoracic kyphotic deformity

Case report

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✓There are many potential risks associated with spinal deformity correction procedures including transient and/or permanent neurological deficits. Typically, neurological deficits caused by the surgical correction of spinal kyphosis occur acutely during surgery or immediately after surgery. Delayed postoperative neurological deficits are extremely rare.

The authors report a case of delayed neurological deficit that occurred 48 hours after surgical correction of thoracic hyperkyphosis. An 18-year-old man with myotonic dystrophy presented with a 110° T7–L1 kyphosis. The patient underwent an uneventful two-stage correction procedure of the hyperkyphotic deformity. First, anterior discectomies and fusion were performed from T-7 to L-1 using rib autograft, and all segmental vessels were preserved. Subsequently, on the same day, the patient underwent posterior Smith–Petersen osteotomies and T7–L2 pedicle screw fixation. Intact somatosensory and motor evoked potentials were maintained throughout both operations. Postoperatively, he remained neurologically intact without sequelae for nearly 48 hours. On postoperative Day 2, the patient developed delayed monoplegia of the left leg and sensory level loss below T-10.

Medical management enabled complete reversal of the patient's monoplegia and sensory loss. At 2-year follow-up, the patient had no adverse neurological sequelae.

In this case, a delayed postoperative neurological deficit occurred following spinal hyperkyphosis correction. The authors discuss the possible etiological mechanisms behind this complication and suggest strategies for its management.

Abbreviations used in this paper:CT = computed tomography; MABP = mean arterial blood pressure; MEP = motor evoked potential; SSEP = somatosensory EP.

Article Information

Address correspondence to: Praveen V. Mummaneni, M.D., Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, M-779, Box 0112, San Francisco, California 94143. email: vmum@aol.com.

© AANS, except where prohibited by US copyright law.

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Figures

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    Preoperative lateral radiograph (A) and sagittal CT reconstruction (B) demonstrating 110° kyphosis from T-7 to L-1.

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    Lateral (upper) and posterior (lower) illustrations showing the process of anterior discectomies and T7–L1 fusion; rib autograft placement, posterior Smith–Petersen osteotomies from T-7 to L-2, and posterior pedicle screw fixation have been performed.

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    Intraoperative photograph obtained after Smith–Petersen osteotomies and placement of a posterior pedicle screw construct.

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    Postoperative lateral radiograph demonstrating correction of the T7–L1 hyperkyphosis from 110 to 64°.

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    Postoperative sagittal reconstructed CT myelogram obtained following onset of a delayed neurological deficit. Note the correction of the hyperkyphosis without spinal canal hematoma or hardware malposition.

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