Case Presentation
A 40 years old woman had mild spine deformity in the form of increased
lumbar lordosis from childhood with no other symptoms. Gait disturbance
started four years earlier and her trunk tilt was exacerbated in the
last two years. 11 months before surgery, the patient started suffering
from urinary problems in the form of increased urinary residual volume
and showed symptoms such as frequency, dribbling, and suprapubic pain.
Two months later, her urinary symptoms worsened and subsequently, she
started having urinary retention resulting in the need to undergo
frequent catheterization. Furthermore, the patient’s gait aggravation,
along with low back pain, disrupted her daily activities. In the
physical examination, she had gait problems, low-grade pelvic tilt, and
severe lumbar lordosis. All lower limb forces, sensory examination,
Upper motor reflexes, and anus sphincter tone were normal.
Radiologically severe CLSJK due to the existence of S1-S2 HV was
identified on Plain x-ray, CT-scan and magnetic resonance imaging
features. (Figure 1,2,3) The patient was operated in prone position and
S1-S2 HV resection was performed through the posterior approach.
Subsequently, pedicle screws were applied from L5 to S2. Lumbarized S1
was reduced partially on S2 and posterior spinal fusion was done using
allograft bone chips mixed with harvested bone from corpectomy. The
neuromonitoring control was performed through the surgery and remained
as the records just before the surgical incision (Fig.4). one year of
follow-up shows that the patient’s gait has improved and her low back
pain has eliminated. The patient can perform daily activities without
restriction. Her urinary retention problem has not yet been completely
eliminated but has improved as compared to before.