Spinal cord infarction after operative stabilisation of the thoracic spine in a patient with tuberculous spondylodiscitis and sickle cell trait.
METHODS
Case report.


OBJECTIVE
To describe and discuss the case of a patient, later recognized to have sickle cell trait (SCT), who suffered from tuberculous spondylodiscitis and developed a spinal ischemia after spinal decompression and stabilization and to discuss the literature on this.


BACKGROUND
Spinal ischemia is a rare event and even more unusual after spinal surgery. Vaso-occlusive complications like strokes occur in patients with sickle cell disease, but spinal ischemia has rarely been reported. SCT is generally seen as a benign disorder with vaso-occlusive complications having been described under extreme conditions.


METHODS
We report the case of a 39-year-old woman, born in Togo and living in Germany for more than 11 years, who presented to our outpatient clinics with a tuberculous spondylodiscitis. She underwent a dorsal decompression and pedicle screw instrumentation from T7-T11.


RESULTS
A few hours after surgery, the patient developed an acute paraplegia of the lower extremities, which accentuated on the left side combined with urinary incontinence and anal sphincter dysfunction but without sensory deficits of the lower extremities. A CT-scan and a second-look surgery revealed no cause for the symptoms. A magnetic resonance imaging showed that the patient had suffered spinal ischemia worst at the T4 level. On further investigation she was noted to have SCT.


CONCLUSIONS
We assume that the combination of the patient's SCT status and the physiologic stress of surgery likely explain this patient's spinal ischemia.
Department of Orthopaedic Surgery, Grobetahadern Medical Center, Ludwig Maximilian University, Munich, Germany. Patrick.Weber@med.uni-muenchen.de
Patrick
P
Weber
Tobias
T
Vogel
Harro
H
Bitterling
Sandra
S
Utzschneider
Christoph
C
von Schulze Pellengahr
Christof
C
Birkenmaier
D000328:Adult; D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D007238:Infarction / Q000175:diagnosis / Q000209:etiology; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D012805:Sickle Cell Trait / Q000150:complications*; D013116:Spinal Cord / Q000473:pathology; D020760:Spinal Cord Ischemia / Q000175:diagnosis* / Q000209:etiology; D013904:Thoracic Vertebrae / Q000098:blood supply / Q000473:pathology / Q000601:surgery*; D014399:Tuberculosis, Spinal / Q000150:complications / Q000601:surgery*