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Acute Paraparesis Due to Protrusion of a Disc Following Lateral Interbody Fusion for Degenerative Kyphoscoliosis

A Case Report

Ruchirawan, Surawut, MD1; Fujita, Nobuyuki, MD, PhD2; Yagi, Mitsuru, MD, PhD2; Tsuji, Osahiko, MD, PhD2; Okada, Eijiro, MD, PhD2; Nagoshi, Narihito, MD, PhD2; Ishii, Ken, MD3; Nakamura, Masaya, MD, PhD2; Matsumoto, Morio, MD, PhD2; Watanabe, Kota, MD, PhD2

doi: 10.2106/JBJS.CC.18.00002
Case Reports

Case: A 74-year-old woman presented with severe trunk deformity. Radiographs revealed severe sagittal and coronal imbalance with spinal canal stenosis at L4 to L5. Anterior cages were placed at L2 to L3, L3 to L4, and L4 to L5. Three days later, posterior correction surgery from T5 to the ilium with decompression at L4 to L5 was performed. At 30 minutes after surgery, leg muscle strength severely deteriorated. Emergency surgery revealed disc fragments protruding into the spinal canal at L2 to L3.

Conclusion: Because posteriorly placed extreme lateral interbody fusion (XLIF) cages can be a risk factor for disc protrusion into the spinal canal, computed tomographic evaluation or prophylactic posterior decompression should be considered before the correction procedure.

1Spine Unit, Department of Orthopaedics, Chaing Mai University, Thailand

2Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan

3Department of Orthopedic Surgery, School of Medicine, International University of Health and Welfare, Chiba, Japan

E-mail address for K. Watanabe:

Investigation performed at the Department of Orthopedic Surgery, Keio University School Medicine, Tokyo, Japan

Disclosure: The authors indicated that no external funding was received for any aspect of this work. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (

Copyright © 2019 by The Journal of Bone and Joint Surgery, Incorporated
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