L5 Vertebral Column Resection for Correction of Severe Lumbar Hyperlordosis and Pelvic Anteversion in an Adolescent With Prior Myelomeningocele Repair and Lumbar Fusion: Case Report

BACKGROUND AND IMPORTANCE

Lumbar hyperlordosis in ambulatory children is an uncommon but potentially problematic spinal deformity, and the operative management has not been comprehensively described.

CLINICAL PRESENTATION

We report the case of a 14-yr-old girl presenting with severe progressive lumbar hyperlordosis (-122°) and sagittal imbalance (-6 cm). She had multiple prior surgeries, including myelomeningocele repair at 10 d old, midlumbar meningioma resection at 8 mo old, and posterior lumbar instrumented spinal fusion at 5 yr old. She presented with progressive lumbosacral back pain and intermittent numbness in her left lower extremity, and severe skin contractures over her prior posterior incisions. From an all posterior approach, prior implants and dural scar were removed and then an L5 vertebral column resection (VCR) was performed to disarticulate her lumbar spine from her anteverted pelvis, allowing for slow distraction forces to correct her lumbar hyperlordosis. This was followed by a T7-sacrum fusion using pedicle screws and iliac screws, with autologous bone graft and plastic surgery wound closure. Postoperatively, lumbar lordosis was corrected to -55° and sagittal balance reduced to -0.5 cm. At 10-wk and 14-mo follow-ups, the patient reported resolution of her back pain with no limitations in physical activities. Dramatic improvement was seen in both her preoperative to 14-mo postoperative Oswestry Disability Index (ODI) (54 to 12) and Scoliosis Research Society Scoliosis Research Society (SRS)-22r (54 to 93) scores.

CONCLUSION

This case highlights a rare presentation of severe progressive lumbar hyperlordosis in an ambulatory adolescent after myelomeningocele repair, meningioma resection, and posterior lumbar instrumented spinal fusion with subsequent surgical treatment incorporating important components of both spinal and plastic surgery involvement.

Non-surgical reduction of lumbar hyperlordosis, forward sagittal balance and sacral tilt to relieve low back pain by Chiropractic BioPhysics® methods: a case report

[Purpose] To present the reduction of both lumbar spine hyperlordosis and anterior sagittal balance in a symptomatic patient as treated by Chiropractic BioPhysics^® technique. [Participant and Methods] A 46 year old reported with low back and hip pains for six years. Oswestry disability index scored 28%. Radiographic assessment revealed pronounced anterior sagittal balance with lumbar hyperlordosis. The patient was treated by Chiropractic BioPhysics technique to reverse the spinal deformity subluxation via mirror image corrective exercises and spinal traction, as well as spinal manipulative therapy. [Results] Assessments after 36 and 74 treatments corresponding to the 4-month and 13-month check-ups demonstrated a continuous structural improvement in lumbar spine biomechanical parameters. There was a near complete resolution in low back and hip pains with an Oswestry score of 4%. [Conclusion] This case documents the reduction of lumbar spine hyperlordosis and forward sagittal balance by contemporary spine rehabilitation methods. It is essential to screen spinal subluxation patterns via standing radiography which obviously, as demonstrated in this case determines treatment approach as most low back pain patients present with lumbar hypolordosis. Routine initial and repeat radiography is safe in the screening and monitoring of treatment efficacy and is the standard for evidence-based, patient-centred structural rehabilitation.