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

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.

Keywords: Cerebral palsy; Hyperlordosis; Magnetically controlled growing rods; Slow deformity correction; Spasticity; Viscoelastic.