SCOLIOSIS COMPLICATED BY PARAPLEGIA


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Abstract

We believe this to be the first reported case of scoliosis complicated by paraplegia in a man in the fifth decade of life. Since the patient's history is non-contributory and there is no evidence of any recent increase in the deformity, it is difficult to explain the unusually late onset of the paralysis. The scoliosis is similar in type and degree to those previously described; it is a severe dorsal kyphoscoliosis with marked deviation and rotation deformity of the thoracic vertebrae.During the laminectomy two causes were found for the neurological symptoms. One was the severe angulation and rotation of the cord, and the other was pressure on the cord by a nubbin of bone on the concave side of the curvature at the level of the apex of the deformity. The spur of bone invaded the neural canal and lay against the cord. Either factor alone, and certainly both in combination, would have been sufficient to cause compression of the cord. The scoliosis which appeared in childhood was probably of the idiopathic variety, but might also belong to the group which the senior author has classified as congenital scoliosis without manifest malformation of bone, such as wedged vertebrae and asymmetrical development3.The lesson which this case holds for us is that, as soon as a case of structural scoliosis shows signs of cord compression, an adequate decompression laminectomy should be promptly performed and the area of compression thoroughly explored for such compressive elements as a spur of bone, a tight dural band, or taut nerve roots. In some cases transposition of the cord is necessary to relieve it completely from undue pressure.

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