Isolated painless scoliosis in lumbar disc herniation
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How to cite this article: Akhaddar A, Arabi H. Isolated painless scoliosis in lumbar disc herniation. Surg Neurol Int 2020;11:159.
To the Editor,
Painful scoliosis and lumbar disc herniations (LDHs) are well documented in the pediatric, adolescent, and young adult populations.[1-3] However, isolated painless scoliosis and LDH rarely occur together and are often misdiagnosed as idiopathic scoliosis for long periods of time.
CASE REPORT
A 24-year-old male presented with a 12-month history of progressive scoliosis and difficulty walking without spinal or radicular pain. For the past several months, he had been misdiagnosed as having idiopathic scoliosis and was being treated with bracing and physical therapy without any improvement. On examination, he had a significant scoliotic deformity (i.e., tilt to the left) with a reduced range of lumbar motion and/muscle spasm restricting right lateral flexion [Figure 1]. He had no other focal neurological deficits. Plain radiographs showed a primary right lumbar curve (Cobb angle 30° and 70 mm deviation) without a rotational spinal deformity [Figure 2a]. The spinal CT scan and MR studies showed a right paramedian LDH at the L4–L5 level [Figure 2b-d]. Following a conventional right L4–L5 open discectomy, the “deformity” resolved, and the patient was neurologically intact demonstrating no recurrent symptoms 2 years later [Figure 3].
CONCLUSION
In the pediatric, adolescent, and young adult populations, and acute LDH should be ruled out with MR studies as potential causes of and/or contributing to “deformity” before assigning a diagnosis of thoracolumbar scoliosis.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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