Correction of kyphoscoliosis
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OPEN OPERATING THEATRE (OOT)
Correction of kyphoscoliosis Max Aebi
Springer-Verlag Berlin Heidelberg 2013
Keywords Post irradiation spinal deformity Kyphoscoliosis Post actinic paravertebral and abdominal muscle atrophy Secondary lipomatosis Adult secondary deformity Adult scoliosis due to poor muscle resources
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To understand a complex secondary deformity in a patient post irradiation due to Hodgkin lymphoma with destruction of the paravertebral and abdominal muscles and replacement with scar tissue and lipomatosis. To understand the character of a progressive adult degenerative scoliosis and its indication for surgery. Progressive kyphosis in flexion between spine and pelvis on one side and legs on the other side, evaluation of the hip extensors as the counterforce to maintain a straight spine when the spine is corrected and aligned with the pelvis. Learning how to use instrumentation in a combination of severe deformity and osteoporosis.
Electronic supplementary material The online version of this article (doi:10.1007/s00586-013-3101-1) contains supplementary material, which is available to authorized users. M. Aebi (&) Orthopaedic Department, Hirslanden Salem Hospital, Bern, Switzerland e-mail: [email protected]
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Introduction This patient was presented to us with a severe deformity, following massive irradiation because of a Morbus Hodgkin in the years 1981 and 1982. This is an exceptional case of a patient, which is walking mainly flexed and looking down at the floor because the scar formation of the abdominal wall basically pulls the patient forward in a flexed position between trunk and pelvis. This patient has significant risk factors, locally due to osteoporosis and generally due to a status after thromboembolic disease and lung embolism in 1986 and 1988 and therefore anticoagulation since then. This case should demonstrate the careful preparation to avoid any possibly unforeseen complications during surgery.
Case description The patient is a 58-year-old lady who suffered from a severe Morbus Hodgkin in 1981 and 1982, at this time chemotherapy as well as severe irradiation of the pelvis and the trunk to basically destroy all the lymph nodules paravertebral and in the inguina. Following this treatment, the patient also developed a severe thromboembolic disease with embolism to the lungs in 1986 and again in 1988. For this reason, the patient is under permanent anticoagulation.
Watch surgery online
Eur Spine J (2013) 22:2918–2920
When the patient presented herself, she could walk with canes to support her trunk, which is completely flexed in relation to the pelvis. The patient needs to have a massive hyperextension of the neck to see forward. If not hyperextended in the neck, the patient looks at the ground. This patient can be straightened out by lying on a bed and in hyperextension, so it seems that the problem is between the pelvis and the trunk respectively the lumbar and thoracic spine. The patient is able to extend the hips due to strong glutea
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