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Circumferential fusion for severe post surgical cervical kyphosis.

Singh SK, Srivastava C, Ojha BK, Chandra A - Asian J Neurosurg (2015 Jan-Mar)

Bottom Line: The child presented 10 months after surgery for a C3-C4 intramedullary cyst with neck deformity and near tetraplegic state.The combined anterior-posterior approach is preferred for severe angulations or for those cases not correctable by a single approach.A purely posterior approach may be the only option for those cases where the anterior approach is impossible.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, King Georges Medical University, Lucknow, India.

ABSTRACT
Cervical kyphosis-though a common occurrence after surgery and other conditions like trauma, infections, etc., is usually restricted to around 20-40°. It is more common in children. Angulations of more than 70-80° are exceedingly uncommon and present more treatment challenges. We discuss here the management of a 14-year-old child with a severe postoperative cervical kyphotic angulation of 92°. The child presented 10 months after surgery for a C3-C4 intramedullary cyst with neck deformity and near tetraplegic state. He underwent a combined anterior-posterior approach for correction after a trial of skull traction. Six months after the surgery, the child was ambulatory with almost total correction of the deformity. Surgical correction of postoperative cervical kyphosis usually involves a posterior approach for small angles and an anterior approach for larger angulations. The combined anterior-posterior approach is preferred for severe angulations or for those cases not correctable by a single approach. A purely posterior approach may be the only option for those cases where the anterior approach is impossible.

No MeSH data available.


Related in: MedlinePlus

Sagittal T2 MRI done before the correction surgery. Post laminectomy, severe kyphosis can be seen with the spinal cord compressed and draped over the kyphotic vertebral bodies
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Figure 2: Sagittal T2 MRI done before the correction surgery. Post laminectomy, severe kyphosis can be seen with the spinal cord compressed and draped over the kyphotic vertebral bodies

Mentions: A 14-year-old child presented 10 months after a C3-C4 laminectomy for an intramedullary cyst (Neurenteric cyst) [Figure 1] with complaints of increasing tetraparesis and neck flexion deformity. Imaging revealed severe cervical kyphosis with anterior cord compression and a focal syrinx [Figure 2]. He had only 1-2/5 power in the lower limbs. The measured Cobbs angle (C3-C5) was 92° [Figures 2 and 3]. Sequential skull traction was applied up to 8 kg for 7 days, which resulted in only partial angle correction to 74°. Thereafter, anterior C4-C5 corpectomy was performed. The patient was turned prone and C2, C3-C5, C6 posterior instrumentation was performed after radiologically confirming normal lordotic realignment preoperatively. Pedicle screws (3.5 mm × 24 mm, Gesco make) were inserted at C2 while lateral mass screws (3.5 mm × 12 mm) were inserted at the other levels. C4 lateral mass was not included in the construct because partial facetectomy had already been done. The patient was then placed supine again and iliac bone grafting and C3-C6 plating (rigid locking screw-plate, Gesco make) was done. Postoperative radiology revealed that the kyphosis had been completely corrected (Cobbs angle 2°) [Figure 4]. Philadelphia collar was applied for 12 weeks.


Circumferential fusion for severe post surgical cervical kyphosis.

Singh SK, Srivastava C, Ojha BK, Chandra A - Asian J Neurosurg (2015 Jan-Mar)

Sagittal T2 MRI done before the correction surgery. Post laminectomy, severe kyphosis can be seen with the spinal cord compressed and draped over the kyphotic vertebral bodies
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4352625&req=5

Figure 2: Sagittal T2 MRI done before the correction surgery. Post laminectomy, severe kyphosis can be seen with the spinal cord compressed and draped over the kyphotic vertebral bodies
Mentions: A 14-year-old child presented 10 months after a C3-C4 laminectomy for an intramedullary cyst (Neurenteric cyst) [Figure 1] with complaints of increasing tetraparesis and neck flexion deformity. Imaging revealed severe cervical kyphosis with anterior cord compression and a focal syrinx [Figure 2]. He had only 1-2/5 power in the lower limbs. The measured Cobbs angle (C3-C5) was 92° [Figures 2 and 3]. Sequential skull traction was applied up to 8 kg for 7 days, which resulted in only partial angle correction to 74°. Thereafter, anterior C4-C5 corpectomy was performed. The patient was turned prone and C2, C3-C5, C6 posterior instrumentation was performed after radiologically confirming normal lordotic realignment preoperatively. Pedicle screws (3.5 mm × 24 mm, Gesco make) were inserted at C2 while lateral mass screws (3.5 mm × 12 mm) were inserted at the other levels. C4 lateral mass was not included in the construct because partial facetectomy had already been done. The patient was then placed supine again and iliac bone grafting and C3-C6 plating (rigid locking screw-plate, Gesco make) was done. Postoperative radiology revealed that the kyphosis had been completely corrected (Cobbs angle 2°) [Figure 4]. Philadelphia collar was applied for 12 weeks.

Bottom Line: The child presented 10 months after surgery for a C3-C4 intramedullary cyst with neck deformity and near tetraplegic state.The combined anterior-posterior approach is preferred for severe angulations or for those cases not correctable by a single approach.A purely posterior approach may be the only option for those cases where the anterior approach is impossible.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, King Georges Medical University, Lucknow, India.

ABSTRACT
Cervical kyphosis-though a common occurrence after surgery and other conditions like trauma, infections, etc., is usually restricted to around 20-40°. It is more common in children. Angulations of more than 70-80° are exceedingly uncommon and present more treatment challenges. We discuss here the management of a 14-year-old child with a severe postoperative cervical kyphotic angulation of 92°. The child presented 10 months after surgery for a C3-C4 intramedullary cyst with neck deformity and near tetraplegic state. He underwent a combined anterior-posterior approach for correction after a trial of skull traction. Six months after the surgery, the child was ambulatory with almost total correction of the deformity. Surgical correction of postoperative cervical kyphosis usually involves a posterior approach for small angles and an anterior approach for larger angulations. The combined anterior-posterior approach is preferred for severe angulations or for those cases not correctable by a single approach. A purely posterior approach may be the only option for those cases where the anterior approach is impossible.

No MeSH data available.


Related in: MedlinePlus