Thoracolumbar kyphoscoliotic deformity with neurological impairment secondary to a butterfly vertebra in an adult

Abstract

Study design: Case report.

Objective: To describe a rare case of thoracolumbar kyphoscoliosis secondary to a butterfly vertebra in an adult, and its surgical correction technique.

Background: Kyphoscoliosis secondary to an isolated butterfly vertebra is rare and its management can be very challenging.

Methods: We report the case of a 39-year-old male, complaining of chronic middle and low back pain with unsteady gait and altered sensation of lower extremities. Full spine anteroposterior and lateral X-rays revealed a thoracolumbar kyphosis with an angulation of 60° between T10 and T12, with a short thoracolumbar scoliosis of 32 degrees. CT scan confirmed the presence of a butterfly vertebra at the level of T11 with posterior arch fusion between T10 and T12. MRI showed cord compression at the apex of the kyphosis associated to syringomyelia.

Results: The patient underwent a posterior resection of the T11 butterfly vertebra with instrumentation from T8 to L2, and use of a one-sided domino on the convex side and a mesh cage on the concave side for asymmetrical correction and vertebral height preservation. Thoracolumbar kyphosis was corrected to 10°. Scoliosis was corrected to 6°. He could walk on day 2 with a satisfactory clinical and radiological result at 2 years.

Conclusion: Literature is sparse on the management of thoracolumbar kyphoscoliosis secondary to butterfly vertebra in the context of neurological impairment. The current case described a surgical treatment strategy to correct both deformity planes simultaneously by a vertebral resection performed through a posterior only approach.

Keywords: Butterfly vertebra; Congenital kyphosis; Kyphoscoliosis; Thoracolumbar; Vertebral column resection.