高弘　Takahiro 飯塚　Iizuka

Fatal Complications On 3 Dimentional Reconstruction For Degenerative Lumbar Kyphoscoliosis In An Elderly A Case Repoort On Cardiovascular Complication In Spinal Correction Surgery T. Iizuka, T. Takai, T. Kashiro, T. Iwami, H. Debat Fatal Complications on 3 Dimentional Reconstruction for Degenerative Lumbar Kypho-Scoliosis in an Elderly A Case Report on Cardiovascular Complication in Spinal Correction Surgery Authors, Takahiro IIZUKA ,MD. PhD. １）A.Kashiro MD, １）T. Iwami MD, １）H. Debata,MD. １）T.Takai MD.１） １）　Department of Orthopaedic Spine Surgery　　TAKAI Hospital , JAPAN Introduction Degenerative Lumbar Kypho-Scoliosis (DLS) is often challenging when surgery is required because of its pathologies which require not only decompression but also 3-dimentional correction of spinal curvature. 3-Dimentional reconstruction of spinal curvature in sagittal and coronal plane is the mainstay in recent spinal surgeries evaluating SVA,PT,PI and LL－PI<10. We have been treated DLS patients with posterior decompression, derotation/correction of curvature and fusion technique. Benefits are often reported on correction surgery of spinal balance. In our series we experienced a case with cardiovascular complication in DLS patient. This case is considered to be related to the correction of spinal curvature. However little reports on anterior soft tissues (anterior cardiovascular) are found in literatures. Aims ① To report fatal risk of 3 Dimentional spinal correction surgery for DLS ② to sound the alarm on anterior cardiovascular function Patients and Method A case is reported regarding risk on 3 Dimentional reconstruction surgeries. A Case : Cardiovascular complication with decrease of inferior vena cava blood return 74 y.o. female who diagnosed as DLS (SVA:110mm, LL:10,PI:47,PT:15,Cobb 38) . She suffered intractable neural pain in both legs and disability in standing because of loss of spinal global balance. Pre-operative evaluation showed neural compression with lambar canal stenosis and pancreas cyst on MRI and CT-myelography. Surgery was aimed to decompression and correction of Kypho-scoliosis with instrumentations. Surgery was performed according to the pre-operative planed maneuver without any surgical problems throughout the surgery using autologous transfusion/intraoperative blood salvage (blood loss 800g and operation time 4.5h). At the time of closing the skin, blood pressure was rapidly got down to 50‐60 mmHg. We suspected pulmonary embolism(PE) , and quickly closed the skin with staples. CT scan showed no suspicious PE and intraperitoneal bleeding. Cardinal angiography showed Takotsubo cardiomyopathy (Left Ventricular Apical Ballooning Syndrome). The cause of rapid cardiomyopathy may be cause by surgical stress ie. Pain and Hypo-inferior vena cava blood return. In this case huge pancreas cyst and correction of spinal curvature might obstruct the inferior vena cava blood return. Discussion/Conclusion Spinal reconstruction with correction global balance is the mainstay in spinal surgeries. However, little attention is paid for anterior cardiovascular function at the planning of surgery. Correction of sagittal balance for DLS may cause the stretch of anterior soft tissues (inferior vena cava and gastro-intestinal organs). This maneuver is quite valid from the point of view ie. global spinal balance. Besides, too much correction may result in unexpected cardiovascular function at correction of DLS patients whose anterior soft tissues must be stiff. Monitoring of central vena cava pressure (CVP) may be also required at the planning of DLS correction as well as monitoring MEP.