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Spinal stenosis above a healed tuberculous kyphosis. A case report
1Department of Orthopaedic Surgery, University of Hong Kong, Duchess of Kent Children's Hospital, Hong Kong.
Study Design:
This case report illustrates two patients with paraplegia of late onset resulting from cord compression in the hyperlordotic thoracic or thoracolumbar spine proximal to a healed tuberculous kyphosis.
Objectives:
The objective of this paper is to highlight that degenerative stenosis of the thoracic spine proximal to a healed stable kyphosis can be a cause of paraplegia of healed disease.
Summary Of Background Data:
Paraplegia resulting from tuberculosis of the spine can be of early or late onset. Early onset paraplegia is usually a result of cord compression by active disease. Late onset paraplegia can be due to disease reactivation, bony ridge compression, or unstable kyphosis. To our knowledge, compression of the cord proximal to a healed, stable kyphosis giving rise to paraplegia has never been reported.
Methods:
Patient 1 presented with symptoms of spinal claudication and progressive paraparesis. He was found to have spinal stenosis in the hyperlordotic thoracolumbar spine proximal to a healed lumbosacral tuberculous kyphosis. Patient 2 presented with a 2-year history of progressive paraplegia. Imaging revealed cord compression at the hyperlordotic T10-11 segment by disc protrusion, and facet hypertrophy.
Results:
Laminectomy successfully relieved the first patient of all symptoms but the second patient had significant deterioration of the neurologic status after surgery.
Conclusion:
Compensatory hyperlordosis of the thoracic or thoracolumbar spine commonly occurs in patients with severe tuberculous thoracolumbar or lumbosacral kyphosis. Degenerative spinal stenosis and cord compression at such hyperlordotic segment can cause late onset paraplegia. The blood supply of these chronically compressed cords is precarious and the risk of surgery is high.