Diagnosing and Treating Symptomatic Thoracic Kyphosis
Surgeons from the Kyoto University School of Medicine report on a rare case of thoracic kyphosis causing serious problems for an 84-year old man. Thoracic kyphosis refers to an increased forward curve in the middle of the back. He was unable to walk more than 50 meters with a walker. Symptoms of dysesthesia in both legs kept him from walking farther. Dysesthesia is an unpleasant numbness caused by a normal, everyday activity like walking or touch to the bottom of the feet.

The patient had three operations to his spine in the two years before coming to the Kyoto University. Severe low back pain (LBP), right leg pain, and dysesthesia in both legs were not improved after any of the operations.

X-rays including special X-rays of the moving spine, CT scans, and MRIs were taken to help figure out what was wrong. The thoracic spine was bent so far forward that the spinal cord was stretched and draped over the vertebral bones.

Surgery to restore a more normal upright position of the spine was done with posterior fusion. Special rods were used to hold the spine in place. Special precautions and modifications were made during the operation due to the patient's old age.

Six months later this gentleman could walk more than 400 meters with a single crutch. X-rays showed that the surgery was able to hold the thoracic spine in good alignment. The spinal cord was no longer stretched out.

The authors suggest elderly patients with walking disability and severe thoracic kyphosis may be suffering from a thoracic flexion myelopathy. Myelopathy refers to any disorder of the spinal cord. In this case, pressure and stretching of the spinal cord were causing problems. Posterior fusion of the spine with metal rods and a large bone graft was safe and effective for this patient and should be considered for others with this same problem.
References
Shunsuke Fujibayashi, MD, PhD, et al. Flexion Myelopathy of the Thoracic Spine. Case Report. In Journal of Neurosurgery: Spine. January 2007. Vol. 6. No. 1. Pp. 68-72.