Objective: To
compare a case of thoracic myelopathy secondary to degenerative thoracic
spondylolisthesis with previously reported cases and radiologically assess the
cause of degenerative thoracic spondylolisthesis.
Summary
and background data: The thoracic and costovertebral joints provide
relative stability to the upper and middle thoracic spine. Therefore, thoracic
myelopathy of the lower thoracic spine associated with degenerative thoracic
spondylolisthesis is rare. We report a case of degenerative spondylolisthesis
of T11 associated with thoracic myelopathy.
Methods: A 76
year old woman with numbness in both lower limbs and gait disturbance was
diagnosed with grade I degenerative spondylolisthesis of T11 on plain
radiography according to the Meyerding classification. Stenosis of the spinal
canal at T11-T12 and signal changes in the spinal cord were observed on
sagittal T2-weighted MR images. Myelography identified an incomplete block at
T11-T12 and computed tomography images showed severe facet joint degeneration
between T11 and T12. A posterior decompression was performed combined with
fixation of T11 and T12.
Results: The
pedicle-facet joint angle at T11 was 124°, which was larger than that at T10
(99°) and T12 (97°).
INTRODUCTION
The thoracic and
facet joints provide flexion-extension stability to the upper and middle
thoracic spine. However, very few cases of thoracic myelopathy in the
thoracolumbar area (lower thoracic spine level) due to spondylolisthesis have
been reported. We report a patient with degenerative spondylolisthesis of T11
who presented with thoracic myelopathy.
CASE REPORT
History and clinical examination
SURGICAL PROCEDURE
Postoperatively there
was an improvement in the spasticity of the lower limbs and poor gait, but the
numbness persisted. The patient was able to walk using a wheeled walker at a
follow-up examination after 2 years.
DISCUSSION
The thoracic and costovertebral joints
provide support and stability to the upper and middle thoracic spine, relative
to the lumbar spine. However, similar structures do not exist in the
thoracolumbar area, thus greater mobility often causes spondylosis [3]. A paper
by Aizawa et al. [4] revealed that thoracic myelopathy affects mostly the lower
thoracic spine, especially at Th11/12 and that 52% of these cases are
associated with ossification of the ligamentum flavum, especially in Asian
patients while only 8% are associated with thoracic spondylosis. Thoracic
spondylolisthesis is rare, especially degenerative spondylolisthesis, because
the facet joints are parallel to the coronal plane at the thoracic level.
Extensive search of the PubMed 1990-2013
library and the Japan Medical Abstracts Society (JAMAS) showed 5 only
such cases [1,2,5,6]. Ishibashi et al. [1] suggested that
intervertebral slippage presents with large arch angles. In the present case,
the PFJA between T11 and T12 was 124°, which indicated leveling of the T11
facet joint.
CONCLUSION
·
A rare case of
myelopathy secondary to thoracic spondylolisthesis was experienced.
·
We performed
posterior decompression with fixation for this case.
1. Ishibashi
K, Ishii Y, Yamazaki S (1999) Thoracic myelopathy due to degenerative
spondylolisthesis in the lower thoracic spine: A report of two cases. Orthop
Surg Traumatol 42: 1369-1373 (in Japanese).
2. Otoshi
K, Watanabe E, Watanabe T (2000) A case of degenerative thoracic
spondylolisthesis. Tohoku Seisai Kiyo 44: 25-28 (in Japanese).
3. Sato
T, Kokubun S, Tanaka Y (1998) Thoracic myelopathy in the Japanese:
Epidemiological and clinical observations on the cases in Miyagi prefecture.
Tohoku J Exp Med 184: 1-11.
4. Aizawa
T, Sato T, Tanaka Y (2006) Thoracic myelopathy in Japan: Epidemiological
retrospective study in Miyagi prefecture during 15 years. Tohoku J Exp Med 210:
199-208.
5. Shimada
Y, Kasukawa Y, Miyakoshi N (2006) Spondylolisthesis of the thoracic spine. J
Neurosurg Spine 4: 415-418.
6. Nishimura
S, Ishikawa M, Fujita N (2010) Spondylolisthesis of the thoracic spine with
Scheuermann’s disease. Case report. Rinsho Seikei Geka 45: 1153-1157 (in
Japanese).
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