Intraoperative disc herniation during posterior spinal fusion for correction of Scheuermann's Kyphosis.
METHODS
A retrospective case report.


OBJECTIVE
To report a previously unpublished complication associated with surgical correction of Scheuermann's kyphosis (SK).


BACKGROUND
Recently, a review of a large Scoliosis Research Society database reported a 1.9% risk of neurologic injury during surgical correction of SK. Typically, changes in neurophysiological monitoring are attributed to hypoperfusion of the spinal cord during deformity correction and can be treated by elevating the mean arterial blood pressure or by decreasing the amount of correction. However, other reversible etiologies of neurologic compromise theoretically exist as well. SK is associated with degenerative changes in the intervertebral disc, and an intraoperative neural compromise could be due to disc herniations during application of powerful deformity corrective forces.


METHODS
The patient's medical history, physical examination, and diagnostic studies were retrospectively reviewed.


RESULTS
We encountered a previously unreported complication of intraoperative disc herniation causing neural compromise during deformity correction of SK. A 17-year-old patient developed a T10-T11 herniated nucleus pulposus during posterior spinal fusion for SK. We postulate that abnormal intervertebral disc degeneration associated with SK and significant pressure on the middle spinal column during application of the cantilever correction maneuver contributed to the disc herniation, which resulted in acute unilateral leg pain and weakness. To our knowledge, no reported case of this phenomenon has been documented in the literature.


CONCLUSIONS
Surgeons should consider acute disc herniation as a possible etiology for intraoperative neurophysiologic changes.
Department of Orthopaedic Surgery, Drexel University College of Medicine, Philadelphia, PA, USA.
Roald J
RJ
Llado
Steven
S
Hwang
Laury
L
Cuddihy
Patrick
P
Cahill
Amer
A
Samdani
D000293:Adolescent; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D007431:Intraoperative Complications; D007738:Kyphosis / Q000601:surgery*; D007866:Leg / Q000294:innervation / Q000503:physiopathology; D008297:Male; D013123:Spinal Fusion / Q000379:methods*; D013904:Thoracic Vertebrae / Q000473:pathology