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Slow correction of severe spastic hyperlordosis in an adult by means of magnetically expandable rods

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Abstract

Background

We describe a case of severe and progressive lumbar hyperlordosis (160°) in a 28-year-old female university student with cerebral palsy. Her main complaints were abdominal wall pain and increasing inability to sit in her custom wheelchair.

Method

When deciding on our opinion about the most promising treatment strategy, we contemplated slow continued correction by means of percutaneously expandable magnetic rods (MAGEC) after the index surgery as a key component of a satisfactory correction in this severe and rigid curve. After an initial radical release and partial correction, a release and correction procedure was required for the bilateral hip flexion contracture. A final in situ posterior fusion was performed as a second spinal procedure, once the desired final correction at 66° of lumbar lordosis was achieved.

Result

Three years after the completion of surgery, the patient has a stable clinical and radiological result as well as a solid posterior fusion on CT.

Conclusion

This is the first case published in which percutaneous magnetic distraction was successfully used in an adult patient.

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Author information

Authors and Affiliations

  1. Department of Orthopaedics, Physical Medicine and Rehabilitation, Grosshadern Medical Center, Ludwig-Maximilian-University, 81377, Munich, Germany

    Christof Birkenmaier, Melvin D’Anastasi, Bernd Wegener & Carolin Melcher

  2. Medical Imaging Department, Mater Dei Hospital, Marchioninistrasse 15, Tal-Qroqq, Msida, MSD 2090, Malta

    Melvin D’Anastasi

Authors
  1. Christof Birkenmaier
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  2. Melvin D’Anastasi
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  3. Bernd Wegener
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  4. Carolin Melcher
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Corresponding author

Correspondence to Christof Birkenmaier.

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Conflict of interest

No author has a conflict of interest in relation to this work.

Funding

No funding, financial or other material support has been received by any authors in relation to this work.

Informed consent

The patient concerned has given her full and informed consent to this publication.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Video showing the pulsation of the anterior abdominal wall (MP4 3228 kb)

586_2017_5366_MOESM2_ESM.mp4

Composite video from the Angio-CT, showing the immediate subcutaneous locations of the aortic bifurcation, the iliac vein confluens and the stretched-out peritoneum at the apex of the deformity. (MP4 6638 kb)

586_2017_5366_MOESM3_ESM.mov

360° rotating visualization of a 3-D reconstruction of the patient’s axial skeleton (including proximal femurs) at the end of the stepwise distraction procedures. There is a harmonious relationship between thoracic kyphosis, lumbar lordosis and pelvic orientation. (MOV 4125 kb)

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Birkenmaier, C., D’Anastasi, M., Wegener, B. et al. Slow correction of severe spastic hyperlordosis in an adult by means of magnetically expandable rods. Eur Spine J 27, 1671–1678 (2018). https://doi.org/10.1007/s00586-017-5366-2

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  • DOI: https://doi.org/10.1007/s00586-017-5366-2

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