title: Thoracic compression myelopathy due to the progression of dystrophic scoliosis, the presence of a paraspinal tumor, and high and excessive amplitude movement of the shoulder.
abstract: The authors present a case of 45-year-old man with neurofibromatosis type 1 (NF-1) and thoracic scoliosis, previously undergoing fusion surgery, who developed myelopathy. This patient further complained of lightning pain when he extended and horizontally abducted the convex-side shoulder. Radiological examination revealed the progression of dystrophic scoliosis with opened spinal canals and the presence of a neurofibroma behind the spinal cord at the apical levels. Delayed development of spinal instability can occur due to dystrophy even postoperatively in patients with NF-1. After tumor resection, he had rapid recovery from myelopathy and no recurrence of radiating pain despite shoulder movement. These findings provide a speculation that high, intense amplitude movement of the shoulder toward the spinal canal causes the impingement on the neurofibroma, resulting in indirect compression of the exposed spinal cord. This is the first report describing thoracic compression myelopathy associated with paraspinal displacement of the scapula.
authors.affiliation: 1 Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kurosawa
authors.affiliation: 1 Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Yurube
authors.affiliation: 1 Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Kakutani
authors.affiliation: 1 Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Maeno
authors.affiliation: 2 Department of Orthopaedic Surgery, National Hospital Organization Kobe Medical Center, Kobe, Japan.
authors.forename: Koki
authors.initials: K
authors.lastname: Uno
authors.affiliation: 1 Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kurosaka
authors.affiliation: 1 Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Kotaro
authors.initials: K
authors.lastname: Nishida
mesh_terms: D018450:Disease Progression; D006801:Humans; D008297:Male; D008875:Middle Aged; D009456:Neurofibromatosis 1 / Q000473:pathology*; D016059:Range of Motion, Articular; D012600:Scoliosis / Q000150:complications* / Q000601:surgery; D012785:Shoulder Joint; D013115:Spinal Canal; D013117:Spinal Cord Compression / Q000209:etiology*; D013125:Spinal Neoplasms / Q000473:pathology*; D013904:Thoracic Vertebrae
keywords: dystrophic type scoliosis; fusion surgery; neurofibromatosis; paraspinal tumor; scapula displacement; shoulder movement; spine; thoracic compression myelopathy