Thoracolumbar kyphoscoliotic deformity with neurological impairment secondary to a butterfly vertebra in an adult.

STUDY

DESIGN

Case report.

OBJECTIVE

To describe a rare case of thoracolumbar kyphoscoliosis secondary to a butterfly vertebra in an adult, and its surgical correction technique.

BACKGROUND

Kyphoscoliosis secondary to an isolated butterfly vertebra is rare and its management can be very challenging.

METHODS

We report the case of a 39-year-old male, complaining of chronic middle and low back pain with unsteady gait and altered sensation of lower extremities. Full spine anteroposterior and lateral X-rays revealed a thoracolumbar kyphosis with an angulation of 60° between T10 and T12, with a short thoracolumbar scoliosis of 32 degrees. CT scan confirmed the presence of a butterfly vertebra at the level of T11 with posterior arch fusion between T10 and T12. MRI showed cord compression at the apex of the kyphosis associated to syringomyelia.

RESULTS

The patient underwent a posterior resection of the T11 butterfly vertebra with instrumentation from T8 to L2, and use of a one-sided domino on the convex side and a mesh cage on the concave side for asymmetrical correction and vertebral height preservation. Thoracolumbar kyphosis was corrected to 10°. Scoliosis was corrected to 6°. He could walk on day 2 with a satisfactory clinical and radiological result at 2 years.

CONCLUSION

Literature is sparse on the management of thoracolumbar kyphoscoliosis secondary to butterfly vertebra in the context of neurological impairment. The current case described a surgical treatment strategy to correct both deformity planes simultaneously by a vertebral resection performed through a posterior only approach.