揭露肌病：一例青少年特发性脊柱侧凸矢状面失衡术后恶化。

IF 0.7 Q4 SURGERY

International Journal of Surgery Case Reports Pub Date : 2025-09-22 DOI:10.1016/j.ijscr.2025.111977

Mohammadreza Golbakhsh , Sina Esmaeili , Mohammad Soleimani , Abbas Rahimian , Parham Talebiyan

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引用次数: 0

摘要

简介：脊柱侧凸是一种复杂的脊柱畸形，具有多种病因，需要根据其分类（先天性、神经肌肉性或特发性）量身定制的管理策略。病例介绍：我们报告了一名14岁的女孩，在青少年特发性脊柱侧凸（AIS）脊柱融合手术后出现严重矢状位失衡和步态障碍。术后检查发现一种未确诊的核心肌病，以颈椎屈肌无力为特征，通过肌电图和肌肉活检证实，这导致她的矢状不平衡，需要代偿性颈椎过伸和胸屈曲。讨论：这个误诊为特发性而非神经肌肉性脊柱侧凸的病例强调了对非典型患者进行全面术前评估的重要性，包括神经肌肉评估。为了避免进一步的手术干预，患者接受了保守的职业治疗，导致部分功能改善。结论：本病例强调需要多学科方法和警惕，以识别可能使脊柱侧凸治疗复杂化的潜在条件。证据等级：四级（病例报告）。

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

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.