Department of Neurosurgery, University Hospital Münster, Münster, Germany.
J Neurol Surg A Cent Eur Neurosurg. 2022 Jan;83(1):69-74. doi: 10.1055/s-0040-1721003. Epub 2021 Feb 14.
Kyphosis is the most common deformity of the cervical spine leading to development of severe disabilities. In case of fused kyphosis, surgical treatment can be demanding and often requires multiple-step procedures for adequate correction. We present a technique of single-stage pedicle subtraction osteotomy (PSO) of C3 to treat a patient with fused kyphosis of C2 and C3 causing spinal stenosis with subsequent myelopathy.
A 53-year-old man presented with progressive myelopathy not able to walk with 6/18 points on the modified Japanese Orthopedic Association scale. Horizontal gaze was lost due to cervical kyphosis. Magnetic resonance imaging (MRI) revealed a cervical kyphosis causing stenosis, cord compression, and kinking; computed tomography (CT) showed substantial anterior and posterior fusion of C2 and C3.
Surgery included decompression via laminectomy of C2 to C6 in combination with PSO of C3 and additional dorsal instrumentation of C2 to C6. Cervical spinal alignment was corrected, as the C2-C4 Cobb angle was reduced from 48.9 to 20.6 degrees. Horizontal gaze was restored. Postoperative MRI demonstrated full decompression of the cord without kinking of the vertebral arteries. No complications were noted. The patient recovered well with restoration of his ability to walk.
Single-stage pedicle subtraction closing wedge osteotomy in the upper cervical spine, although a demanding surgical procedure, is an alternative treatment option in selected cases of fused and severe cervical kyphosis. In contrast to multiple-step approaches, the single-stage procedure could reduce operating time and may thus decrease complications.
后凸畸形是颈椎最常见的畸形,导致严重残疾。在融合性后凸的情况下,手术治疗可能具有挑战性,通常需要多步手术才能充分矫正。我们介绍了一种 C3 经椎弓根楔形截骨术(PSO)的技术,用于治疗 C2 和 C3 融合性后凸导致脊髓狭窄和随后出现的脊髓病的患者。
一名 53 岁男性因进行性脊髓病就诊,无法行走,改良日本矫形协会评分得 6/18 分。由于颈椎后凸,水平凝视丧失。磁共振成像(MRI)显示颈椎后凸导致狭窄、脊髓压迫和扭曲;计算机断层扫描(CT)显示 C2 和 C3 的前、后融合广泛。
手术包括 C2 至 C6 的椎板切除术减压,结合 C3 的 PSO 和 C2 至 C6 的额外后路器械固定。颈椎脊柱排列得到矫正,C2-C4 Cobb 角从 48.9 度减少到 20.6 度。水平凝视得到恢复。术后 MRI 显示脊髓充分减压,椎动脉无扭曲。无并发症。患者恢复良好,行走能力恢复。
尽管单阶段颈椎上椎弓根楔形截骨术是一种具有挑战性的手术,但在特定的融合性和严重颈椎后凸病例中,它是一种替代治疗选择。与多步手术相比,单阶段手术可减少手术时间,从而可能降低并发症发生率。