title: Intraoperative neurological deterioration secondary to spinal kyphotic change after cervicothoracic junction laminectomy.
abstract: METHODS
  Case report.
  
  
  OBJECTIVE
  We report a case in which intraoperative spinal kyphosis after laminectomy led to neurological deterioration during intramedullary spinal cord tumor surgery at the cervicothoracic junction (CTJ).
  
  
  BACKGROUND
  CTJ is a transitional zone between the cervical and thoracic spine; this region can be easily affected by mechanical stress. Although postoperative spinal instability or kyphosis after laminectomy at CTJ has been reported, no reports of intraoperative neurological deterioration after laminectomy exist.
  
  
  METHODS
  The patient was a 40-year-old female with an intramedullary spinal cord tumor at T2-T4, which was suspected to be an ependymoma. She had no neurological deficit before the surgery. Although tumor removal surgery using a posterior approach was planned, the waves observed on intraoperative neurophysiological monitoring in the bilateral lower extremity disappeared soon after laminectomy.
  
  
  RESULTS
  The waveform reappeared when we manually corrected the kyphosis at CTJ by pushing the spine. However, when we stopped the manual correction, the waveform disappeared again. The cause of neurological deterioration was strongly suspected to be a spinal kyphosis secondary to laminectomy. We removed the tumor after posterior instrumentation, and her neurological status was restored in 3 months postoperatively.
  
  
  CONCLUSIONS
  A minimal change in spinal alignment secondary to laminectomy could be a cause of intraoperative neurological deterioration during surgery at CTJ. Spinal fixation using spinal instrumentation should be performed before laminectomy, particularly in patients with preoperative neurological damage or severe spinal cord compression at CTJ.
  
  
  METHODS
  4.
authors.affiliation: From the Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nakashima
authors.forename: Shiro
authors.initials: S
authors.lastname: Imagama
authors.forename: Zenya
authors.initials: Z
authors.lastname: Ito
authors.forename: Kei
authors.initials: K
authors.lastname: Ando
authors.forename: Hiroki
authors.initials: H
authors.lastname: Matsui
authors.forename: Kenichi
authors.initials: K
authors.lastname: Hirano
authors.forename: Ryoji
authors.initials: R
authors.lastname: Tauchi
authors.forename: Akio
authors.initials: A
authors.lastname: Muramoto
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Matsumoto
authors.forename: Norimitu
authors.initials: N
authors.lastname: Wakao
authors.forename: Naoki
authors.initials: N
authors.lastname: Ishiguro
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000601:surgery*; D019054:Evoked Potentials, Motor; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000473:pathology; D007738:Kyphosis / Q000473:pathology*; D007796:Laminectomy / Q000009:adverse effects*; D013117:Spinal Cord Compression / Q000473:pathology*; D013120:Spinal Cord Neoplasms / Q000601:surgery; D013904:Thoracic Vertebrae / Q000601:surgery*