A case report of severe degenerative lumbar scoliosis associated with windswept lower limb deformity
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CASE REPORT
Open Access
A case report of severe degenerative lumbar scoliosis associated with windswept lower limb deformity Xi Yang, Qiang Zou, Yueming Song*, Limin Liu and Chunguang Zhou
Abstract Background: The windswept lower limb deformity describes valgus deformity in one leg with varus deformity in the other. It is mostly seen in young children with metabolic bone diseases (such as rickets) and may lead to leg length discrepancy (LLD) and Degenerative scoliosis (DS) in older age. To the best of our knowledge, there was no report of the spinal surgery in patient with severe DS associated with windswept deformity. The objective of this study is to report the unique case of a 60-year-old woman with severe degenerative scoliosis (DS) associated with windswept deformity caused by rickets who underwent a posterior correction and fusion surgery in spine. Case presentation: The patient was diagnosed as rickets windswept lower limb deformity for 50 years but never went through routine treatment. Then, she performed lumbar scoliosis for more than 20 years and suffered from severe back pain for 4 years. After overall clinical evaluation and radiographic measures, we performed a posterior surgical correction and fusion from T9-L5. With this surgery, the main thoracolumbar curve Cobb angle corrected from 72.5° to 21.0°, the coronal balance from 0 cm to 2.0 cm while the sagittal vertical axis (SVA) from 1.5 cm to − 1.0 cm. At 2 years postoperative follow-up, her back pain has almost completely relieved with a satisfied fixation and bone fusion showed on CT scans. However, a coronal imbalance was found with C7-CSVLdistance equal to 4.0 cm. This coronal imbalance was highly correlated to the untreated LLD and pelvic obliquity, and should be improved by standing posture or shoe lifts. Conclusions: For such patient, the pure spinal correction and fusion surgery, in spite of lower limbs deformity, can achieve good relieve of back pain symptom, however may accompany by the complication of coronal imbalance due to the unimproved pelvic obliquity and LLD. However, longer follow-up is necessary to observe the long-term outcome of this patient’s postoperative coronal imbalance. Keywords: Degenerative scoliosis, Windswept lower limb deformity, Leg length discrepancy, Pelvic obliquity, Rickets
Background Degenerative scoliosis (DS) is a common condition in elderly patients [1]. The multiple factors associated with aging, including disc degeneration, facet joint arthrosis and vertebral rotatory olisthesis, have been recognized as main cause of DS [2–4]. Besides these, the leg length discrepancy (LLD) appearing during growth period has * Correspondence: [email protected] Department of Orthopedics Surgery and Orthopedics Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Road, Chengdu, Sichuan, China
been considered as an initiating factor of DS in recent [5, 6]. The windswept lower limb deformity describes a kind of rare appearance of abnormal valgus deformity in one knee in association with varus deformity in
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