Asian Spine J.  2013 Mar;7(1):55-59. 10.4184/asj.2013.7.1.55.

Acute Paraplegia Secondary to Thoracic Disc Herniation of the Adjacent Segment Following Thoracolumbar Fusion and Instrumentation

Affiliations
  • 1Department of Orthopedic Surgery, Clemenceau Medical Center, Beirut, Lebanon. mohammad.badra@cmc.com.lb
  • 2Department of Neurosurgery, Lille University Hospital, Lille, France.

Abstract

Proximal junctional disease is a well-recognized postoperative phenomenon in adults who are undergoing long thoracolumbar fusion and instrumentation, and is attributed to increased a junctional stress concentration. In general, the onset of symptoms in these patients is insidious and the disease progresses slowly. We report on a contrary case of rapidly progressing paraplegia secondary to acute disc herniation at the proximal adjacent segment after long posterior thoracolumbar fusion with cement augmentation at the upper instrumented vertebra and the supra-adjacent vertebra. The patient was treated with a discectomy through the costo-transverse approach combined with extension of the posterior instrumentation. The patient's neurological status improved markedly. Stress concentration at the proximal junction disc space may have caused accelerated disc degeneration which in turn lead to this complication.

Keyword

Thoracic disc herniation; Adjacent segment disease; Instrumented thoracolumbar fusion; Paraplegia

MeSH Terms

Adult
Diskectomy
Humans
Intervertebral Disc Degeneration
Paraplegia
Spine
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