Unmasking myopathy: A case of postoperative worsening of sagittal imbalance in adolescent idiopathic scoliosis

Abstract

Introduction

Scoliosis is a complex spinal deformity with diverse etiologies, requiring tailored management strategies based on its classification as congenital, neuromuscular, or idiopathic.

Presentation of case

We present the case of a 14-year-old girl with severe sagittal imbalance and gait impairment following spinal fusion surgery for adolescent idiopathic scoliosis (AIS). Postoperative investigations revealed an undiagnosed core myopathy characterized by cervical flexor weakness, confirmed through electromyography and muscle biopsy, which contributed to her sagittal imbalance by necessitating compensatory cervical hyperextension and thoracic flexion.

Discussion

This misdiagnosis of her scoliosis as idiopathic rather than neuromuscular underscores the importance of comprehensive preoperative evaluations, including neuromuscular assessments, in patients with atypical presentations. Avoiding further surgical intervention, the patient was managed conservatively with occupational therapy, resulting in partial functional improvement.

Conclusion

This case emphasizes the need for multidisciplinary approaches and vigilance in recognizing underlying conditions that may complicate scoliosis treatment.

Level of evidence

Level IV (Case Report).