Cervical Gibbectomy for Rigid, Rounded Kyphosis in Pediatric Patient: Surgical Planning with Technical Note

Abstract

Cervical kyphosis surgery poses a significant challenge to spine surgeons. Etiologies of cervical kyphosis are many, each having its own outcome and treatment challenges. Irrespective of the etiology, the treating physician should consider all options fully to improve function and prevent neurologic worsening. We outline management principles and decision making in the case of a rigid, rounded kyphosis of the cervical spine and highlight the technique of an internal gibbectomy procedure, which has never been reported in the cervical spine. We report a case of Ewing sarcoma of the cervical spine that presented with progressive myelopathy symptoms. The patient was operated on multiple times (anterior and posterior) and presented to us with rigid, rounded global kyphosis of the cervical spine. We performed internal gibbectomy from a posterior approach and decompressed the neural tissue. The patient had a satisfactory recovery in myelopathy symptoms, and the modified Japanese Orthopaedic Association score improved at subsequent follow-ups. There was no recurrence at 2-year follow-up. Internal gibbectomy can be a treatment option in rigid, rounded kyphosis in which the primary goal of surgery is neural decompression.