Effect of decompressive surgery on spine balance in congenital lumbar kyphoscoliosis: anatomical aspect with a case report

Year 2018, Volume: 12 Issue: 2, 105 - 110, 15.08.2018

Vaner Köksal Seda Avnioğlu

Abstract

The lumbar vertebral column is a complex structure formed by the fusion of intervertebral joints. It protects the spinal cord

by wrapping around it, carries most of the body’s weight and creates a flexible structure for the body. As individuals with

congenital deformities of the lumbar vertebral column age, they develop some changes in the anatomy of the spine and

with some consequences. In this case, a 35-year-old male patient had a deteriorated posture together with back pain since

childhood. He had walking difficulty and numbness in two legs during walking for the last three years. He fell due to a sudden

brake while he was travelling afoot by bus in 2015. He was admitted to the emergency service with loss of strength in

two legs. Lumbar CT and MRI showed a severe narrowing of the spinal canal due to lumbar kyphoscoliosis. The patient had

neurological deficits after hyperflexion trauma. The patient underwent emergency decompressive surgery due to marked

paraparesis and narrow spinal canal. At the end of the first post-operative month, his clinical complaints were almost completely

resolved, and his biomechanical balance did not show radiological deterioration. While the anatomical change that

occurred during the natural course of congenital kyphoscoliosis increased the stability of the lumbar spine, it severely narrowed

the spinal canal and affected the spinal nerves and thereby caused severe neurological deficits.

Keywords

balance, kyphoscoliosis, lumbar, narrow spinal canal, congenital deformity

References

• 1. Crisco III, J. J., and M. M. Panjabi. "Euler stability of the human ligamentous lumbar spine. Part I: Theory." Clinical Biomechanics 7.1, 1992; 19-26.
• 2. Bogduk, Nikolai. Clinical anatomy of the lumbar spine and sacrum. Elsevier Health Sciences, 2005.
• 3. Avnio¤lu S, Köksal V, Ertekin T. Hypertrophy of the transverse ligament caused by os odontoideum: a case report. Anatomy 2017; 11(3):149–152.
• 4. Hui, H., Zhang, Z. X., Yang, T. M., He, B. R., & Hao, D. J. Vertebral column resection for complex congenital kyphoscoliosis and type I split spinal cord malformation. European Spine Journal, 2014; 23(6): 1158-1163.
• 5. McMaster, Michael J., and Harwant Singh. "Natural history of congenital kyphosis and kyphoscoliosis. A study of one hundred and twelve patients." JBJS 81.10, 1999; 1367-83.
• 6. Tsou, P. M.; Yau, A.; and Hodgson, A. R.: Embryogenesis and prenatal development of congenital vertebral anomalies and their classification. Clin. Orthop., 1980;152: 211-231.
• 7. Liu, C. J., Zhu ZQ, Duan S, Wang KF, Xia WW, Xu S, Liu HY."Radiological analysis of coronal and sagittal spinopelvic parameters in patients with degenerative lumbar kyphoscoliosis." Zhonghua wai ke za zhi [Chinese journal of surgery] 56.2, 2018; 147-152.
• 8. Lee, B. H., Yang, J. H., Kim, H. S., Suk, K. S., Lee, H. M., Park, J. O., & Moon, S. H. Effect of Sagittal Balance on Risk of Falling after Lateral Lumbar Interbody Fusion Surgery Combined with Posterior Surgery. Yonsei medical journal, 2017; 58(6): 1177-1185.
• 9. Özer A,F, Kaner T, Bozdoğan Ç. Omurgada Sagital Denge. "Sagittal balance in the spine." Turkish Neurosurgery 24.1, 2014; 13-19.
• 10. Karademir M., Karavelioğlu E., Boyacı M. G., & Eser O. Omurgada sagittal dengenin önemi ve spinopelvik parametreler. The jornal of Turkish spinal surgery, 2014; 25(2): 139-148.
• 11. Wang, Y., Zhang, Y., Zhang, X., Huang, P., Xiao, S., Wang, Z., ... & Mao, K. A single posterior approach for multilevel modified vertebral column resection in adults with severe rigid congenital kyphoscoliosis: a retrospective study of 13 cases. European Spine Journal, 2008; 17(3): 361-372.
• 12. Suk, S. I., Kim, J. H., Kim, W. J., Lee, S. M., Chung, E. R., & Nah, K. H. Posterior vertebral column resection for severe spinal deformities. Spine, 2002; 27(21): 2374-2382.
• 13. Shimode, M., Kojima, T., & Sowa, K. Spinal wedge osteotomy by a single posterior approach for correction of severe and rigid kyphosis or kyphoscoliosis. Spine, 2002; 27(20): 2260-2267.