Case 1 . Myelogram. The lateral view of the thoracic spine demonstrates the kyphosis but there is no sharp inden- tation of the dye column. Much of the contrast material has been placed extradurally. M. D. Ryan, FRCS Ed, FRACS Professor T. K. F. Taylor, DPhil, FRCS, FRCS Ed, FRACS Department of Orthopaedics and Traumatic Surgery, Royal North Shore Hospital, St Leonards, New South Wales 2065, Australia. Requests for reprints should be sent to Dr M. D. Ryan. © 1982 British Editorial Society of Bone and Joint Surgery 030l-620X/82/4098-0409 $2.00 VOL. 64-B, No. 4, 1982 409 ACUTE SPINAL CORD COMPRESSION IN SCHEUERMANN’S DISEASE M. D. RYAN, T. K. F. TAYLOR From the Department ofOrthopaedics and Traumatic Surgery, Royal North Shore Hospital ofSydney and The University of Sydney Acute myelopathy is a rare complication of Scheuermann’s disease. Three patients are reported where spinal cord compression occurred at the apex of a kyphos. All were male, aged 14, 18 and 20 years, and each had a profound neurological defect associated with a short, sharp kyphos in the low thoracic region. Each patient underwent anterior decompression and all made an almost full recovery. It is deduced that factors which may influence the onset of cord compression include the angle of kyphosis, the number of segments involved, the rate of change of the angle, local anatomical variations, trauma, and possible secondary impairment of the vasculature of the cord. The rarity of spinal cord compression as a compli- cation ofScheuermann’s disease is evident by the paucity of published information on the subject. The literature consists of isolated case reports (Kienbock 1936 ; Wret- blad 1939 ; Gulledge and Bray 1950 ; Malmros 1958; Bradford and Garcia 1969 ; Lonstein et al. 1980). Lonstein et a!., in a comprehensive review of the literature on neurological compromise secondary to spinal deformity, discussed 286 case reports and added 43 patients of their own. Two of their patients had Scheuermann’s disease but they were not discussed in detail. The purpose of the present paper is to report three patients with marked paraparesis due to Scheuermann’s disease who have been treated in our unit over the last 10 years. CASE REPORTS Case 1. An 18-year-old youth had suffered intermittent, low thoracic pain for two months, three years before seeking medical advice. One month before presentation his left leg “went stiff” and his left foot “felt heavy”. On the day of admission when rising from bed he fell, as his legs would not support him. A spastic paraparesis with an upper sensory level at Tl 0 was present with hyper-reflexia, extensor plantar responses and sustained clonus on the left side. His neurological status deteriorated. Osteochondritis at T9-l 1 was noted in the radiographs. Contrast material was obstructed at the T9-l0 level when introduced from below (Fig. I). It was concluded that the spinal cord was compressed from front to back at the T8-lO region due either to acute kyphosis or disc protrusion. Two weeks later the patient had a thoracic laminectomy at T8-l0. At operation the spinal cord was found to be stretched tightly across the protruding posterior aspects of the vertebral bodies. An attempt to decompress the cord was made by making a vertical incision in the dura at T8-lO and suturing a lyophilised dural patch in the defect. Three days later the patient was transferred to our unit. He then had complete motor paralysis below the waist, hyper-reflexia, extensor plantar responses and diminished dorsal column function. It was initially decided to observe progress but as only slight neurological improvement occurred over the ensuing month, a right anterolateral decompression of the thoracic spinal cord was performed at the T8-9 level. The dura was still tightly stretched across the apex ofthe kyphosis and extensive bone removal was required for adequate decompression, allowing the thecal sac to settle without undue tension on it. A rib graft was inserted between T8 and T9. Progress was uneventful and the
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