A 540° posterior-anterior-posterior approach for 360° fused rigid severe cervical kyphosis: patient series

Qiang Jian,Zan Chen,Jian Guan,Zhenlei Liu,Wanru Duan,Fengzeng Jian

doi:10.3171/case21491

Abstract

BACKGROUNDTreatment of severe rigid 360° fused cervical kyphosis (CK) is challenging and often requires a combined approach for ankylosis release, establishment of sagittal balance, and fixation with fusion.OBSERVATIONSFour patients with iatrogenic 360° fused severe rigid CK (Cobb angle ≥40°) were enrolled for this retrospective analysis. All patients in the case series were female, with an average age of 27 years. All patients previously underwent posterior laminectomy/laminoplasty and cervical tumor resection when they were children (13–17 years). They underwent correction surgery with a 540° posterior-anterior-posterior approach. Preoperative and final follow-up radiography and computed tomography (CT) were used to evaluate kyphosis correction, internal fixation implants, and bone fusion. The preoperative and final follow-up average C2–7 Cobb angles were −32.4° ± 12.0° and 5.3° ± 7.1°, respectively. Preoperative and final follow-up CK angles averaged −47.2° ± 7.4° and −0.9° ± 16.1°, respectively. The mean correction angle was 46.3° ± 9.6°. At final follow-up, CT showed stable fixation and solid bone fusion.LESSONSThe rare iatrogenic severe kyphosis with 360° ankylosis requires a combined approach. The 540° posterior-anterior-posterior approach can completely release the bony fusion, and the CK can be corrected using an anterior plate. This technique can achieve good results and is an effective strategy.

Highlights

Treatment of severe rigid 360° fused cervical kyphosis (CK) is challenging and often requires a combined approach for ankylosis release, establishment of sagittal balance, and fixation with fusion
Flexible CK is reducible with the help of hyperextension and traction; fixed CK is associated with anterior or posterior ankylosis, and no improvement is observed after extension and traction
A combined approach is required for both circumferential lysis and ideal correction angle for iatrogenic, circumferentially fused, severe CK ($40°)

Summary

Introduction

Treatment of severe rigid 360° fused cervical kyphosis (CK) is challenging and often requires a combined approach for ankylosis release, establishment of sagittal balance, and fixation with fusion. All patients previously underwent posterior laminectomy/laminoplasty and cervical tumor resection when they were children (13–17 years). They underwent correction surgery with a 540° posterior-anterior-posterior approach. The preoperative and final follow-up average C2–7 Cobb angles were −32.4° ± 12.0° and 5.3° ± 7.1°, respectively. The 540° posterior-anterior-posterior approach can completely release the bony fusion, and the CK can be corrected using an anterior plate. This technique can achieve good results and is an effective strategy

Methods

Findings

Conclusion