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Pedicle subtraction metallectomy with complex posterior reconstruction for fixed cervicothoracic kyphosis: illustrative case

Harman Chopra, José Manuel Orenday-Barraza, Alexander E. Braley, Alfredo Guiroy, Olivia E. Gilbert, and Michael A. Galgano

BACKGROUND

Iatrogenic cervical deformity is a devastating complication that can result from a well-intended operation but a poor understanding of the individual biomechanics of a patient’s spine. Patient factors, such as bone fragility, high T1 slope, and undiagnosed myopathies often play a role in perpetuating a deformity despite an otherwise successful surgery. This imbalance can lead to significant morbidity and a decreased quality of life.

OBSERVATIONS

A 55-year-old male presented to the authors’ clinic with a chin-to-chest deformity and cervical myelopathy. He previously had an anterior C2–T2 fixation and a posterior C1–T6 instrumented fusion. He subsequently developed screw pullout at multiple levels, so the original surgeon removed all of the posterior hardware. The T1 cage (original corpectomy) severely subsided into the body of T2, generating an angular kyphosis that eventually developed a rigid osseous circumferential union at the cervicothoracic junction with severe cord compression. An anterior approach was not feasible; therefore, a 3-column osteotomy/fusion in the upper thoracic spine was planned whereby 1 of the T2 screws would need to be removed from a posterior approach for the reduction to take place.

LESSONS

This case highlights the devastating effect of a hardware complication leading to a fixed cervical spine deformity and the complex decision making involved to safely correct the challenging deformity and restore function.

Open access

En bloc resection of a high cervical chordoma followed by reconstruction with a free vascularized fibular graft: illustrative case

Zachariah W. Pinter, Eric J. Moore, Peter S. Rose, Ahmad N. Nassr, and Bradford L. Currier

BACKGROUND

Wide excision of chordoma provides better local control than intralesional resection or definitive radiotherapy. The en bloc excision of high cervical chordomas is a challenging endeavor because of the complex anatomy of this region and limited reconstructive options.

OBSERVATIONS

This is the first case report to describe reconstruction with a free vascularized fibular graft following the en bloc excision of a chordoma involving C1–3.

LESSONS

This report demonstrates the durability of this construct at 10-year follow-up and is the first case report demonstrating satisfactory long-term oncological outcomes after a true margin-negative resection of a high cervical chordoma.

Open access

Traumatic posterior atlantoaxial dislocation without fracture of the odontoid process: illustrative case

Huan-Dong Liu, Ning Li, Wei Miao, Zheng Su, and Hui-Lin Cheng

BACKGROUND

Traumatic posterior atlantoaxial dislocation without fracture of the odontoid process is extremely rare. Only 24 cases have been documented since the first patient was reported by Haralson and Boyd in 1969. Although various treatment strategies are reported, no consensus has been yielded.

OBSERVATIONS

A 58-year-old man experienced loss of consciousness and breathing difficulties after being struck by a car from behind. An immediate computed tomography scan showed subarachnoid hemorrhage, a posterior atlantoaxial dislocation without C1–2 fracture, and a right tibiofibular fracture. After the patient’s respiration and hemodynamics were stabilized, closed reduction was attempted. However, this strategy failed due to unbearable neck pain and quadriplegia, resulting in surgical intervention with transoral odontoidectomy and posterior occipitocervical fusion. The patient developed postoperative central nervous system infection. After anti-infective and drainage treatment, the infection was controlled. At 1-year follow-up, the patient did not complain of special discomfort and was generally in good condition.

LESSONS

The authors report their experience with transoral odontoidectomy and concomitant posterior occipitocervical fusion in a case of posterior atlantoaxial dislocation without related fracture. Although these procedures are highly feasible and effective, particular attention should be paid to their complications, such as postoperative infection.