T12 pedicle subtraction osteotomy for post-laminectomy kyphoscoliotic deformity following resection of a thoracolumbar a
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CASE REPORT
T12 pedicle subtraction osteotomy for post‑laminectomy kyphoscoliotic deformity following resection of a thoracolumbar astrocytoma in an adolescent with a previous paraplegic context Anouar Bourghli1 · Louis Boissiere2 · Ibrahim Obeid2 Received: 25 June 2020 / Accepted: 8 September 2020 © Scoliosis Research Society 2020
Abstract Study design Case report. Purpose To describe a rare case of iatrogenic post-laminectomy thoracolumbar kyphoscoliosis in an adolescent, and its surgical management with pedicle subtraction osteotomy (PSO). Background Kyphoscoliosis secondary to multilevel laminectomies for intradural astrocytoma resection is rare and its management can be very challenging. Methods We report the case of 15-year-old boy who has been complaining of a progressively increasing hump in his back during the past 6 months. Two years prior to presentation, he underwent multilevel thoracolumbar laminectomies from T10 to L2 for resection of an intradural astrocytoma that was causing progressive paraplegia predominant on the right side. Full spine anteroposterior and lateral X-rays revealed a thoracolumbar kyphosis with an angulation of 73° between T10 and L1, with a long left thoracolumbar scoliosis of 24 degrees. CT scan confirmed the multilevel laminectomies and showed T12 anterior wedging. MRI did not show any tumor recurrence. Results The patient underwent T12 PSO with instrumentation from T4 to L3 with the use of a one-sided domino on the convex side. Thoracolumbar kyphosis was corrected to 9°, and scoliosis was corrected to 7°, with a maintained correction at 7 years of follow-up. Conclusion Literature is sparse on the management of post-laminectomy kyphoscoliotic deformity after intradural astrocytoma resection. Despite previous paraplegia context, aggressive correction technique such as PSO can be a safe option if proper management of the scar tissues and adhesions is performed, with satisfactory clinical and radiological long-term results. Keywords Pedicle subtraction osteotomy · Post-laminectomy kyphosis · Iatrogenic · Astrocytoma · Thoracolumbar
Introduction Kyphosis is a condition characterized by positive sagittal malalignment of the spine, and is rarely encountered in the pediatric and adolescent population. It may be due to congenital, traumatic, idiopathic, or neuromuscular conditions [1]. But it may also be iatrogenic, being the result of * Anouar Bourghli [email protected] 1
Orthopedic and Spinal Surgery Department, Kingdom Hospital, P.O.Box 84400, Riyadh 11671, Saudi Arabia
Clinique du Dos, Elsan Jean Villar Private Hospital, Bordeaux, France
2
a post-laminectomy effect secondary to a previous surgical procedure [2]. The progressively evolving deformity may be detected in the form of a gibbosity, especially in the thoracolumbar area, and it may lead to mechanical problems with back pain as sagittal compensatory mechanisms may come into action to maintain the head over the pelvis. Also, neurological compromise may occur in case of a severe deformity. Unlike sc
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