RESUMO
A 16-year-old boy was diagnosed with spondyloptosis of the cervical spine at the C5-6 level with a neurologic deficit following cervical manipulation. He could not move his upper and lower extremities, but the sensory and autonomic function was spared. The pre-operative American Spinal Cord Injury Association (ASIA) Score was B with SF-36 being 25%, and Karnofsky's score was 40%. The patient was disabled and required special care and assistance. We performed anterior decompression, cervical corpectomy at the level of C6 and lower part of C5, deformity correction, cage insertion, bone grafting, and stabilization with an anterior cervical plate. The patient's objective functional score had increased after six months follow up and assessed objectively with the ASIA Impairment Scale (AIS) E or Excellent, SF-36 score 94%, and Karnofsky score was 90%. The patient could carry on regular activity with minor signs or symptoms of the disease. This case report highlights severe complications following cervical manipulation, a summary of the clinical presentation, surgical treatment choices, and a review of the relevant literature. In addition, the sequential improvement of the patient's functional outcome after surgical correction will be discussed.
RESUMO
INTRODUCTION: Occipitocervical fixation (OCF) can provide good fusion rate to treat various craniovertebral junction (CVJ) pathologies. Biomechanically it gives rigid fixation, good fusion rate, and allows for effective decompression. However, rigid fixation on the mobile occipitocervical junction has shortcomings that affect the post-operative clinical functional outcomes and range of motion. This study aimed to evaluate and elaborate the functional outcomes, range of motions, and radiographic findings in our patients underwent OCF. CASE REPORT: We presented a report of 3 patients underwent posterior decompression procedure followed by occipitocervical fixation. All three patients' clinical outcome was assessed clinically by, Japanese Orthopaedic Association (JOA) score and grading, Karnofsky, range of motion and radiographic cervical alignment evaluation parameters. RESULT: All patients have seen improvement (minimal 1 grade in JOA and >30 points of Karnofsky score) in 3 months after the procedure, had a tolerable range of motion limitation, normal range of cervical lordotic and cervical brow vertebral angle (CBVA). Unfortunately, one patient with loss of cranial fixation may be related to history of infection and lack of post-operative wound care. CONCLUSSION: Our cases conclude that Occipitocervical fixation is a safe technique that provides excellent fusion rate with good functional outcome and tolerable range of motion limitation. Due to its unique anatomy and technically demanding, serial post-operative monitoring evaluation of this procedure is paramount.
