Spinal shortening in scoliosis surgery, A case with transitory paraplegia.

STUDY

DESIGN

A case involving a 16-year-old patient with idiopathic adolescent double-major scoliosis is presented. The curve was so rigid that a shortening surgery was done to reduce neurologic risk.

OBJECTIVE

To advise surgeons who are considering this kind of surgical procedure to reduce the neurologic risk involved in correcting scoliosis, may be more dangerous than other, more traditional modes. SUMMARY OF BACKGROUND DATE: The two-stage procedure for anterior resection of a vertebral body followed by posterior resection and fusion by shortening the spine with instrumentation has been reported to be a safe and effective method of correcting deformities and other spinal pathologies.

METHODS

Surgical treatment consisted of two anterior approaches, thoracic lumbotomy and thoracofrenolumbotomy, in which all the discs between 75 and L4 and the vertebral body of T8 were resected, followed by a posterior resection. In the third surgery (posterior resection) a full T8 vertebrectomy was completed, and the gap between the adjacent vertebrae was closed. Then a traditional CD configuration with rod rotation was used, and a thoracoplasty of the rib hump was done.

RESULTS

During the intraoperative wake-up test, the patient did not move her inferior extremities, and it was necessary to partially reverse the shortening of the gap produced by the vertebrectomy. The preoperative and postoperative curves measured 90 degrees/86 degrees and 25 degrees/27 degrees, respectively.

CONCLUSIONS

This procedure appears to be more dangerous than traditional surgery. Partial vertebrectomy as a closing wedge osteotomy of the convexity may be a less risky procedure. The practice of not using bone graft in the intervertebral spaces does not seem to contribute to spinal shortening and increases the pseudoartosis risk.