"Silent" spinal dislocation in a Charcot spine occurring postlaminectomy: case report and review of literature.
A 45-year-old man with transverse myelitis developed an unstable neuropathic spinal arthropathy manifesting as a "silent" L1-L2 dislocation after laminectomy and rhizotomies performed for increased spasticity. Treatment consisted of reduction, posterolateral spinal fusion with Cotrel-Dubousset instrumentation utilizing hooks and pedicular screws, and a posterior lumbar interbody fusion. The authors conclude that laminectomy on a chronic paralytic through the insensate area should be coupled with fusion and instrumentation even if the facet joints and capsules are preserved during the laminectomy.
Luke
D L
DL
Division of Orthopedic Surgery, Washington University School of Medicine, St. Louis, Missouri 63110.
Bridwell
K H
KH
D000328:Adult; D001177:Arthropathy, Neurogenic / Q000209:etiology* / Q000601:surgery; D006801:Humans; D016268:Internal Fixators; D004204:Joint Dislocations / Q000209:etiology* / Q000601:surgery; D007796:Laminectomy / Q000009:adverse effects*; D008159:Lumbar Vertebrae / Q000293:injuries* / Q000601:surgery; D008297:Male; D009128:Muscle Spasticity / Q000601:surgery; D009188:Myelitis, Transverse / Q000150:complications* / Q000601:surgery; D010264:Paraplegia / Q000209:etiology; D013123:Spinal Fusion; D013126:Spinal Nerve Roots / Q000601:surgery