ABSTRACT
OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: Internal gibbectomy can be a treatment option in rigid, rounded kyphosis in which the primary goal of surgery is neural decompression.
Subject(s)
Cervical Vertebrae/surgery , Kyphosis/surgery , Neoplasm Recurrence, Local/surgery , Neurosurgical Procedures , Sarcoma, Ewing/surgery , Child , Decompression, Surgical/methods , Humans , Kyphosis/diagnosis , Male , Neck/surgery , Neoplasm Recurrence, Local/diagnosis , Neurosurgical Procedures/methods , Spinal Cord Diseases/diagnosis , Spinal Cord Diseases/surgery , Treatment OutcomeABSTRACT
Buckling collapse is the term typically used to describe severe kyphosis >100 degrees, characteristically seen in thoracolumbar tuberculosis. Neurofibromatosis is rarely associated with severe cervical kyphosis. Dystrophic changes in vertebra make surgical correction and fusion challenging. Single-stage cervical osteotomies (e.g., pedicle subtraction osteotomy, vertebral column resection) are commonly done in cervicothoracic junction. However, it is technically challenging and associated with high risk of vertebral artery injury, neural injury, etc. when performed in higher cervical spine. Hence in our case we did a staged procedure performing circumferential osteotomy for buckling kyphosis in the midcervical spine. Because it involved midcervical spine and there was no chin-to-chest deformity, we preferred the anterior-posterior-anterior sequence.
