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.