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Spinal cord infarction after operative stabilisation of the thoracic spine in a patient with tuberculous spondylodiscitis and sickle cell trait.

Spine 2009 April 16
STUDY DESIGN: Case report.

OBJECTIVE: To describe and discuss the case of a patient, later recognized to have sickle cell trait (SCT), who suffered from tuberculous spondylodiscitis and developed a spinal ischemia after spinal decompression and stabilization and to discuss the literature on this.

SUMMARY OF BACKGROUND DATA: Spinal ischemia is a rare event and even more unusual after spinal surgery. Vaso-occlusive complications like strokes occur in patients with sickle cell disease, but spinal ischemia has rarely been reported. SCT is generally seen as a benign disorder with vaso-occlusive complications having been described under extreme conditions.

METHODS: We report the case of a 39-year-old woman, born in Togo and living in Germany for more than 11 years, who presented to our outpatient clinics with a tuberculous spondylodiscitis. She underwent a dorsal decompression and pedicle screw instrumentation from T7-T11.

RESULTS: A few hours after surgery, the patient developed an acute paraplegia of the lower extremities, which accentuated on the left side combined with urinary incontinence and anal sphincter dysfunction but without sensory deficits of the lower extremities. A CT-scan and a second-look surgery revealed no cause for the symptoms. A magnetic resonance imaging showed that the patient had suffered spinal ischemia worst at the T4 level. On further investigation she was noted to have SCT.

CONCLUSION: We assume that the combination of the patient's SCT status and the physiologic stress of surgery likely explain this patient's spinal ischemia.

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