Late paraplegia after scoliosis treatment: an uncommon diagnosis.
We report the case of a young girl treated at age 16 for a progressive scoliosis by posterior instrumented arthrodesis. Ten years later, she suddenly developed lumbar pain and paraplegia. The surgical procedure showed a mass infiltrating the vertebral canal and the dural sheath following a supralaminar hook. Histology revealed a diagnosis of leiomyosarcoma. The outcome was poor with a rapid and fatal extension of the tumor. There is nothing to justify a causal link between the scoliosis and the late onset of a malignant tumor. Nevertheless, we discuss the potential role of diagnostic irradiation consecutive to scoliosis monitoring during growth and the potential role of environmental carcinogens like metallic biomaterials. Finally, rapid intrusion of this extraspinal tumor into the dural sheath resulted in a confusing clinical picture and delayed the diagnosis and treatment of the tumor.
Vialle
Raphaël
R
Service de chirurgie orthopédique et traumatologique, Fondation Hôpital Saint Joseph, Paris, France. ravialle@noos.fr
Wolff
Stéphane
S
David
Philippe
P
Lepeintre
Jean-François
JF
Hautefort
Patrick
P
Tadie
Marc
M
D000293:Adolescent; D005260:Female; D006801:Humans; D007890:Leiomyosarcoma / Q000175:diagnosis* / Q000209:etiology; D010264:Paraplegia / Q000175:diagnosis* / Q000209:etiology*; D012600:Scoliosis / Q000150:complications* / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects*; D013125:Spinal Neoplasms / Q000175:diagnosis* / Q000209:etiology