Work

Unmasking myopathy: A case of postoperative worsening of sagittal imbalance in adolescent idiopathic scoliosis

Year: 2025

Type: article

Abstract: INTRODUCTION: Scoliosis is a complex spinal deformity with diverse etiologies, requiring tailored management strategies based on its classification as congenital, neuromuscular, or idiopathic. PRESENTATION OF CASE: We present the case of a 14-year-old girl with severe sagittal imbalance and gait impairment following spinal fusion surgery for adolescent idiopathic scoliosis (AIS). Postoperative investigations revealed an undiagnosed core myopathy characterized by cervical flexor weakness, confirmed through electromyography and muscle biopsy, which contributed to her sagittal imbalance by necessitating compensatory cervical hyperextension and thoracic flexion. DISCUSSION: This misdiagnosis of her scoliosis as idiopathic rather than neuromuscular underscores the importance of comprehensive preoperative evaluations, including neuromuscular assessments, in patients with atypical presentations. Avoiding further surgical intervention, the patient was managed conservatively with occupational therapy, resulting in partial functional improvement. CONCLUSION: This case emphasizes the need for multidisciplinary approaches and vigilance in recognizing underlying conditions that may complicate scoliosis treatment. LEVEL OF EVIDENCE: Level IV (Case Report).

Source: International Journal of Surgery Case Reports

DOI: 10.1016/j.ijscr.2025.111977

Authors: Mohammadreza Golbakhsh, Sina Esmaeili, Mohammad Soleimani, Abbas Rahimian, Parham Talebiyan

Institutions: Tehran University of Medical Sciences, Sina Hospital

Language: English

Topic: Scoliosis diagnosis and treatment

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,090