Usanov E.I., Treier D.V., Zuev I.V.
(Polenov Research Neurosurgical Institute)
Female patient K., aged 11, was admitted to the Institute on June 22, 2000 with complaints of marked weakness in the lower extremities (mainly on the right), gait disturbance with dragging of the right foot, reduced sensations on the trunk and in the lower extremities.
The patient sustained trauma of the thoracic spine in August 1999. In January 2000 there appeared weakness in the right and then left leg and a bit later episodes of periodic incontinence of urine. The patient's examination revealed lower spastic paraparesis, which was more marked in the right extremities, reduced muscular strength in their right (the score of 3) and left (the score of 4) proximal segments, the steppage gait.
MRI examination of June 23, 2000 showed narrowing of the spinal cord (up to 3 mm in diameter) at the level of Th8, conditioned by widening of anterior and posterior subarachnoid spaces at the level of Th7 and Th8 respectively due to a marked adhesive process. Positive myelograms were indicative of block of subarachnoid spaces at the level of Th7 and presence of some mass (an arachnoid cyst) at the level of Th9-Th10.
The patient was operated on July 6, 2000. Laminectomy of Th7-Th9 with meningomyelolysis at this level were performed (Prof. Usanov E.I.). A postoperative period had no peculiarities. The wound healed by first intention. The patient was transferred to the Rehabilitation Department of Children's Municipal Hospital N 22 on the 19th day after the operation.
There were no focal neurologic symptoms in 3.5 months after the operation. The gait restored; functions of pelvic organs were normal. The patient wore a removable jacket.
To demonstrate possibility of developing a gross adhesive process in meningeal structures of the spinal cord in mild spinal trauma, to inform about disability, which can be caused by this process, and to emphasize efficacy of surgical treatment.