Isolated musculocutaneous neuropathy after posterior spine surgery for a patient with a subset of Marfan syndrome: A case report

The authors reported a 58-year-old male who suffered from severe low back pain due to kyphoscoliosis associated with congenital contractural arachnodactyly (CCA), a subset of Marfan syndrome. Posterior spinal corrective fusion surgery from T8 to the pelvis with pedicle subtraction osteotomy at L4 wa...

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Autores principales:	Chizuo Iwai, Kazunari Fushimi, Satoshi Nozawa, Shingo Komura, Shutaro Sawada, Hiroyasu Ogawa, Haruhiko Akiyama
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2022
Materias:	Musculocutaneous neuropathy (MCNP) Peripheral nerve neuropathy Complication Prone position Posterior spine surgery Surgery RD1-811 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/1dffd5cefaeb4f40b86bf546777f87f3
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spelling	oai:doaj.org-article:1dffd5cefaeb4f40b86bf546777f87f32021-11-30T04:16:11ZIsolated musculocutaneous neuropathy after posterior spine surgery for a patient with a subset of Marfan syndrome: A case report2214-751910.1016/j.inat.2021.101440https://doaj.org/article/1dffd5cefaeb4f40b86bf546777f87f32022-03-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2214751921003522https://doaj.org/toc/2214-7519The authors reported a 58-year-old male who suffered from severe low back pain due to kyphoscoliosis associated with congenital contractural arachnodactyly (CCA), a subset of Marfan syndrome. Posterior spinal corrective fusion surgery from T8 to the pelvis with pedicle subtraction osteotomy at L4 was conducted. Because of long upper extremities due to CCA, we had no choice but to keep his shoulders abducted 90°, horizontal flexed 30°, and elbow flexed 120° with the conventional arm table during the surgery. Immediately after the surgery, he complained of numbness on the lateral aspect of his right forearm, difficulty of elbow flexion, and supination. Postoperative upper arm magnetic resonance imaging revealed evidence of coracobrachialis, brachialis, and biceps brachii myositis resulted from denervation by musculocutaneous nerve. We diagnosed his symptoms as postoperative isolated musculocutaneous neuropathy (MCNP) based on physical and radiological findings. Weakness and numbness began to be resolved 1.5 months after the surgery. Active motion of the elbow started to recover two months after the surgery and completely recovered six months postoperatively. The potential cause of our patient’s pathology was regarded to be intraoperative malposition of the abnormal long arms. In conclusion, we reported a case of isolated MCNP after thoracolumbar spine surgery under prone position, which is extremely rare and not well known among surgeons. Therefore, spine surgeons should take care of arm position and joint angle even though prone surgery to prevent MCNP, particularly in the patient with long arm span because of Marfanoid.Chizuo IwaiKazunari FushimiSatoshi NozawaShingo KomuraShutaro SawadaHiroyasu OgawaHaruhiko AkiyamaElsevierarticleMusculocutaneous neuropathy (MCNP)Peripheral nerve neuropathyComplicationProne positionPosterior spine surgerySurgeryRD1-811Neurology. Diseases of the nervous systemRC346-429ENInterdisciplinary Neurosurgery, Vol 27, Iss , Pp 101440- (2022)
institution	DOAJ
collection	DOAJ
language	EN
topic	Musculocutaneous neuropathy (MCNP) Peripheral nerve neuropathy Complication Prone position Posterior spine surgery Surgery RD1-811 Neurology. Diseases of the nervous system RC346-429
spellingShingle	Musculocutaneous neuropathy (MCNP) Peripheral nerve neuropathy Complication Prone position Posterior spine surgery Surgery RD1-811 Neurology. Diseases of the nervous system RC346-429 Chizuo Iwai Kazunari Fushimi Satoshi Nozawa Shingo Komura Shutaro Sawada Hiroyasu Ogawa Haruhiko Akiyama Isolated musculocutaneous neuropathy after posterior spine surgery for a patient with a subset of Marfan syndrome: A case report
description	The authors reported a 58-year-old male who suffered from severe low back pain due to kyphoscoliosis associated with congenital contractural arachnodactyly (CCA), a subset of Marfan syndrome. Posterior spinal corrective fusion surgery from T8 to the pelvis with pedicle subtraction osteotomy at L4 was conducted. Because of long upper extremities due to CCA, we had no choice but to keep his shoulders abducted 90°, horizontal flexed 30°, and elbow flexed 120° with the conventional arm table during the surgery. Immediately after the surgery, he complained of numbness on the lateral aspect of his right forearm, difficulty of elbow flexion, and supination. Postoperative upper arm magnetic resonance imaging revealed evidence of coracobrachialis, brachialis, and biceps brachii myositis resulted from denervation by musculocutaneous nerve. We diagnosed his symptoms as postoperative isolated musculocutaneous neuropathy (MCNP) based on physical and radiological findings. Weakness and numbness began to be resolved 1.5 months after the surgery. Active motion of the elbow started to recover two months after the surgery and completely recovered six months postoperatively. The potential cause of our patient’s pathology was regarded to be intraoperative malposition of the abnormal long arms. In conclusion, we reported a case of isolated MCNP after thoracolumbar spine surgery under prone position, which is extremely rare and not well known among surgeons. Therefore, spine surgeons should take care of arm position and joint angle even though prone surgery to prevent MCNP, particularly in the patient with long arm span because of Marfanoid.
format	article
author	Chizuo Iwai Kazunari Fushimi Satoshi Nozawa Shingo Komura Shutaro Sawada Hiroyasu Ogawa Haruhiko Akiyama
author_facet	Chizuo Iwai Kazunari Fushimi Satoshi Nozawa Shingo Komura Shutaro Sawada Hiroyasu Ogawa Haruhiko Akiyama
author_sort	Chizuo Iwai
title	Isolated musculocutaneous neuropathy after posterior spine surgery for a patient with a subset of Marfan syndrome: A case report
title_short	Isolated musculocutaneous neuropathy after posterior spine surgery for a patient with a subset of Marfan syndrome: A case report
title_full	Isolated musculocutaneous neuropathy after posterior spine surgery for a patient with a subset of Marfan syndrome: A case report
title_fullStr	Isolated musculocutaneous neuropathy after posterior spine surgery for a patient with a subset of Marfan syndrome: A case report
title_full_unstemmed	Isolated musculocutaneous neuropathy after posterior spine surgery for a patient with a subset of Marfan syndrome: A case report
title_sort	isolated musculocutaneous neuropathy after posterior spine surgery for a patient with a subset of marfan syndrome: a case report
publisher	Elsevier
publishDate	2022
url	https://doaj.org/article/1dffd5cefaeb4f40b86bf546777f87f3
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Isolated musculocutaneous neuropathy after posterior spine surgery for a patient with a subset of Marfan syndrome: A case report

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