Exertional myelopathy in type 2 congenital kyphosis

A case of lower-extremity myelopathy induced by physical exertion in a patient with Type 2 (failure of segmentation) congenital kyphosis is reported.

To describe the uncommon presentation of neurologic sequelae in a patient with Type 2 congenital kyphosis.

Various reports have described neurologic sequelae in patients with Type 1 (failure of formation) congenital kyphosis. To the authors' knowledge, no case of Type 2 congenital kyphosis leading to neurologic symptoms has been reported.

A 17-year-old boy presented with a 3-year history of progressively worsening midthoracic back pain. During exertion, numbness developed along the posterior aspects of his legs, and he experienced a wobbly sensation in his lower extremities that prevented his participation in athletic activities. His static and dynamic neurologic examination was unremarkable. However, he developed a wide-based clumsy myelopathic gait when he was asked to run in the halls of the clinic. Magnetic resonance imaging demonstrated that the spinal cord was draped over the posterior vertebral body of T10. Anterior thoracic spinal cord decompression and fusion were performed through a seventh rib thoracotomy using a structural rib graft to fill the defect. The anterior 1 cm of bone was left intact so as not to cause any additional instability.

The patient tolerated the procedure well and had complete resolution of his exertionally dependent myelopathic symptoms. At this writing, 3 years after surgery, he is involved in the Navy ROTC program.

Although Type 2 congenital kyphosis is a rare entity, it should be followed carefully and corrected surgically when appropriate. A history of exertional myelopathy may be an early sign of spinal cord impingement and is an indication for surgical decompression.