Valli P Mummaneni | PubMed Health

PubMed2006

Cervicothoracic kyphosis.

Cervicothoracic kyphotic deformity may inhibit horizontal gaze function, impede activities of daily living, and induce disabling pain. Eventually, some patients develop a chin-on-chest deformity that limits their ability to eat and drink; in the end stage, a few patients also may have difficulty breathing. Progressive kyphosis can stretch the spinal cord leading to myelopathy with progressive lower extremity spasticity and weakness. Indications for surgery include myelopathy, pain, dysphagia or dyspnea owing to kyphosis, and difficulty maintaining a functional horizontal gaze. Patients with unstable cervicothoracic fractures also require surgical fixation. For these patients, surgical goals include deformity correction with restoration of an acceptable forward gaze, re-establishment of sagittal balance, decompression of the spinal cord (if myelopathic), and stable fixation.

Cervical Vertebrae↗

PubMed2003

Cervical osteotomy for the correction of chin-on-chest deformity in ankylosing spondylitis. Technical note.

The correction of chin-on-chest deformity is challenging and requires combined anterior and posterior approaches to the cervical spine. The authors describe a cervical osteotomy technique for the correction of chin-on-chest deformity in patients with ankylosing spondylitis (AS). This procedure can be accomplished using a posterior screw rod construct combined with an anterior hybrid plate system. In patients with AS, a "front-back-front" approach may be necessary because of the deformity's rigidity. The authors describe the complicated intubation and anesthetic requirements for this approach. They performed an anterior discectomy, cervical osteotomy, and unilateral pediculectomy but did not place anterior instrumentation. Via a posterior approach, laminectomies, facetectomies, and the contralateral pediculectomy were then undertaken. A posterior cervical screw/rod system was placed and loosely connected to titanium rods. Intraoperatively the deformity was corrected by placing the neck in extension combined with compression of the posterior screws on the rods. The posterior construct is then tightened. Finally, an anterior cervical approach is performed to place a structural interbody graft and a hybrid anterior cervical plate construct. The authors have successfully used this approach to correct a chin-on-chest deformity in a patient with ankylosing spondylitis. At 1-year follow-up examination, excellent resolution of the deformity and solid fusion had been achieved. They prefer to perform this procedure by using state-of-the-art anterior and posterior instrumentation systems.

Bone Plates↗