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69. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Mexikanischen und Kolumbianischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

03.06. - 06.06.2018, Münster

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Multisegmental lumbar corporectomy and transcorporal fixation for correction of extreme thoracolumbar kyphosis in paraplegia with chronic decubitus

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  • Felix Kiepe - Medizinische Hochschule Hannover, Neurochirurgie, Hannover, Deutschland
  • Elvis J. Hermann - Medizinische Hochschule Hannover, Neurochirurgie, Hannover, Deutschland
  • Helga Henseler - Medizinische Hochschule Hannover, Plastische, Ästhetische, Hand- und Wiederherstellungschirurgie, Hannover, Deutschland
  • Peter M. Vogt - Medizinische Hochschule Hannover, Plastische, Ästhetische, Hand- und Wiederherstellungschirurgie, Hannover, Deutschland
  • Joachim K. Krauss - Medizinische Hochschule Hannover, Neurochirurgie, Hannover, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 69. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Mexikanischen und Kolumbianischen Gesellschaft für Neurochirurgie. Münster, 03.-06.06.2018. Düsseldorf: German Medical Science GMS Publishing House; 2018. DocV039

doi: 10.3205/18dgnc040, urn:nbn:de:0183-18dgnc0409

Published: June 18, 2018

© 2018 Kiepe et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: There are no standard treatments for extreme thoracolumbar kyphosis approaching an angle of 180° in disfigurement subsequent to myelomeningocele. We here present a new surgical method to correct this deformity to allow healing of chronic decubitus.

Methods: Treatment was planned according to multiple preoperative imaging studies. The subsequent operative steps were performedin a single-stage surgery. First a 3-level lumbar corporectomy with occlusion of the spinal thecal sac was performed. Subsequently, one of the rejected vertebrae was configurated to fit in the gap between the thoracic and the caudal lumbar spine, and the wedge shaped graft was the reinserted to bridge the cavity. The graft was fixed via an axial lumbar interbody fusion technique with titanium screws. The skin was closed using a rotation flap.

Results: A 5 year old boy from Iraq presented with myelomeningocele and extreme thoracolumbar kyphosis causing chronic decubitus of the gibbus region. The patient had complete paraplegia with anaesthesia of his legs and lack of bladder and bowel control. The surgical procedure was performed in a multidisciplinary setting without complications. Postoperative short- and longterm follw-up examinations at 36 months showed a solid boney fusion and proper wound healing.

Conclusion: We describe a novel technique for correction of extreme thoracolumbar kyphosis in complete paraplegia. Although such cases are rarely encountered, appropriate treatment algorithms need to be established.

Figure 1 [Fig. 1], Figure 2 [Fig. 2]