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Fracture Above Fusion a.k.a Proximal Junctional Kyphosis

Patient History: 68-year-old woman presented with severe back pain and enlarging hump on her back. She was experiencing occasional shortness of breath night and found it difficult to sleep on her back. She had a history of scoliosis which she was aware of. She noticed worsening of her shoulder balance, increasing back pain and leaning leftward. 

She did well with her first surgery to correct the scoliosis. However, 2 months after surgery she experienced a fracture of the top vertebrae leading to paraplegia. She was taken to the operating room immediately where the spinal cord compression was relieved and vertebral column realignment corrected.

Surgery: The patient's first surgery was a T3–pelvis scoliosis correction and fusion. She did very well with this surgery. Unexpectedly, she experienced a fracture of the top vertebral level. This resulted in immediate paraplegia. Dr. Rahman performed a complex spinal decompression and osteotomy known as a vertebral column resection. This was done in order to relieve the circumferential pressure off her spinal cord. This procedure is reserved for only the most severe spinal cases and requires experience, exception of training and meticulous detail in order to be successful.

Proximal Junctional Kyphosis

Fig.1 Frontal View Xray Showing Thoracic Curve

Fig.1 PA View Corrected

Fig.2 Frontal View Xray Showing Correction of Thoracic Curve

Fig.2 Lateral View

Fig.3 Side View Xray Showing Thoracic Kyphosis

Fig.2 Lateral View Correct

Fig.4 Side View Xray Showing Correction of Thoracic Kyphosis

 T3 Vertebrae Top of Fusion Fracture

Fig.1 Sagittal CT View

Fig.1 Side View Showing (Sagittal Plane) CT Scan Thoracic Vertebra 3 Fractured

Fig.3 Sagittal CT View  Corrected

Fig.2 Side View Showing (Sagittal Plane) CT Scan after T3 Vertebra Corrected

Fig.2 Coronal CT View Thoracic Vertebra 3

Fig.3 Transverse View Showing (Axial Plane) CT Scan Thoracic Vertebra 3 Fractured

Fig.4 Coroanal CT View Corrected

Fig.4 Transverse View Showing (Axial Plane) of CT Scan Thoracic Vertebrae 3 after Correction

Fig.1 PA View Corrected

Fig.1 Frontal View Xray Showing Correction of Thoracic Curve

Proximal Junctional Kyphosis

Fig.2 Frontal View Xray Showing Correction after T3 Vertebra Collapsed

Fig.2 Lateral View Correct

Fig.3 Side View Xray Showing Correction of Thoracic Kyphosis

Fig.2 Lateral View Corrected

Fig.4 Side View Xray Showing Correction after T3 Vertebra Collapsed

Outcome: After months of rehabilitation, the patient walked into Dr. Rahman's office without the use of a cane or walker. The patient is now a community ambulator without the use of assistive devices.