A novel anterior technique for simultaneous single-stage anterior and posterior cervical release for fixed kyphosis

Abstract

The incidence rate of kyphosis of the cervical spine after a laminectomy can be as high as 20% after a multilevel laminectomy. The loss of the posterior tension band leads to increased load on the vertebral body and discs, leading to further degenerative changes and kyphotic deformities. The initial decompression of the spinal cord disappears as the cord is stretched over the anterior lesions. Muscle damage and facet degeneration from prior surgery contribute to additional pain, muscle spasm, and motion. Occasionally prior surgical fusion that fails to address the kyphosis or spontaneous fusion in a kyphotic position (observed more in laminectomies performed in the growing spine) can result in a challenging rigid deformity with anterior vertebral body and lateral mass facet fusion. For this fixed deformity, anterior and posterior release are often necessary for restoration of lordosis, which can result in the need for a 540 degrees procedure. In this report the authors describe an anterior technique for simultaneous anterior and posterior lateral mass release. The vertebral artery is mobilized using this technique, allowing for its lateral retraction. The nerve roots are visualized and retracted superiorly and inferiorly. The lateral mass and facets can then be accessed anteriorly using an osteotome or drill for the release. The authors illustrate this technique in a patient who developed fixed scoliosis and kyphosis of the cervical spine after surgery for degenerative disc disease. To the authors' knowledge, this is the first report of this technique.