chin-on-chest deformities. These risks are related to the shortening of the posterior column produced by closure of the posterior osteotomy and may include buckling dura, kinking of the spinal cord, and stretching injuries in the lower cervical nerve roots produced by pressure from the C6 or C7 pedicles ( Fig. 1 right). 10–12 C/T PSO requires retraction of the nerve roots during the excision of the posteriorly based wedge in the vertebral body and therefore carries an inherent risk of nerve root injury. A simple crosswise cut through the C7 vertebral body, as in
Andrzej Maciejczak, Andzelina Wolan-Nieroda, and Agnieszka Guzik
Praveen V. Mummaneni, Valli P. Mummaneni, Regis W. Haid Jr., Gerald E. Rodts Jr., and Rick C. Sasso
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.
Daniel J. Hoh, Paul Khoueir, and Michael Y. Wang
that are undiagnosed or poorly managed also contribute to delayed deformity. The fused osteoporotic spine creates long lever arms, which are particularly susceptible to fracture at junctional levels, even with minor trauma. Cervicothoracic or thoracolumbar fractures that subsequently heal in flexion worsen the overall kyphosis. Patients with severe spinal deformity can progress to significant disability. Fixed cervical flexion with a chin-on-chest deformity leads to difficulty with forward vision, swallowing, hygiene, and social outlook ( Fig. 2 ). The nature of
Michael Karsy, Neal Moores, Faizi Siddiqi, Douglas L. Brockmeyer, and Robert J. Bollo
described in the pediatric population, these techniques may be technically challenging because of the smaller size of the oronasopharynx. 38 These difficulties are often exacerbated in the context of associated congenital anomalies, such as midface hypoplasia, which can be encountered in children with abnormalities of the cervical spine. Furthermore, anterior access to the subaxial cervical spine can be challenging when small anatomy is combined with severe cervical kyphosis or chin-on-chest deformity. A variety of pathological conditions may be treated by anterior
Benjamin Kolb, John Large, Stuart Watson, and Glyn Smurthwaite
A nkylosing spondylitis is a chronic rheumatic condition in which inflammation induces microscopic structural damage of the spine. 8 Macroscopic changes occur, with fixed kyphosis due to fusion of the vertebral bodies and facet joints. 10 Structures including the hips, sacroiliac joints, and spine are affected, with chin-on-chest deformity of the cervical and thoracic spine representing one of the most debilitating changes. The systemic effects of ankylosing spondylitis on the cardiovascular, respiratory, and neurological systems have important implications
Vedat Deviren, Justin K. Scheer, and Christopher P. Ames
February 2008 and September 2010, 11 patients underwent a modified PSO (at C-7 in 9 cases, at C-6 and C-7 in 1 case, and at T-1 in 1 case; Table 1 ). The average age of the 11 patients was 70 years (range 52–94 years). Indications for surgery included a sagittal imbalance of the cervical spine affecting horizontal gaze, persistent pain despite conservative treatment, inability to maintain an erect posture, and progressive deformity. Seven patients had chin-on-chest deformity, 3 had severe cervical kyphosis, and 1 had fixed coronal and sagittal plane cervical deformity
Luke G. F. Smith, Nguyen Hoang, Ammar Shaikhouni, and Stephanus Viljoen
instrumentation, but in biomechanical testing the system has proved to have higher load to failure rates. 15 Case Reports Case 1 History and Examination A 70-year-old female who had undergone extensive spinal surgery at an outside institution including occipital condyle-to-ilium fixation for chin-on-chest deformity presented with an altered mental status. Her prior cervical instrumentation had begun with a single-level posterior fusion for progressive spondylolisthesis after a traumatic unilateral facet fracture. Over a period of 2 years, she had progressive cervical deformity
Paul Khoueir, Daniel J. Hoh, and Michael Y. Wang
C ervical kyphotic deformities develop secondary to a variety of pathological processes. 1 In severe cases, cervical kyphosis can cause significant impairment in forward vision and limit basic daily activities such as swallowing and maintaining hygiene. 7 Eventually, progression of cervical kyphosis to a chin-on-chest deformity can result in difficulty with ambulation, dysphagia, dyspnea, and pain. 7 Furthermore, severe kyphosis can cause weakness and myelopathy as the spinal cord becomes draped over the anterior spinal column. Medical management is of
Matthew K. Tobin, Daniel M. Birk, Shivani D. Rangwala, Krzysztof Siemionow, Constantin Schizas, and Sergey Neckrysh
R igid cervical kyphotic deformity represents a very difficult to treat pathology. Its etiology is multifactorial and includes traumatic injuries, degenerative changes, ankylosing spondylitis, and, quite often, iatrogenic factors including postlaminectomy syndrome. The picture becomes more complicated with the presence of either anterior or posterior instrumentation. Traditionally, rigid cervical kyphotic deformity, or “chin-on-chest deformity,” has been measured by the chin-brow vertical angle (CBVA). 6 , 14 , 15 , 25 , 31 This angle is a measurement of
Cervicothoracic junction kyphosis: surgical reconstruction with pedicle subtraction osteotomy and Smith-Petersen osteotomy
Presented at the 2009 Joint Spine Section Meeting
Srinath Samudrala, Shoshanna Vaynman, Ty Thiayananthan, Samer Ghostine, Darren L. Bergey, Neel Anand, Robert S. Pashman, and J. Patrick Johnson
S evere kyphotic deformity at the CTJ distorts the sagittal balance of the upper spine and results in significant morbidity and problems of forward gaze, hygiene, chewing and swallowing, chronic neck pain, and myelopathy. 5 , 32 Cervicothoracic junction kyphosis is a variable disorder with the most severe cases presenting as chin-on-chest deformities. Kyphotic deformity of the CTJ is an extremely rare but rapidly progressive condition that requires surgical intervention. In such cases the goal of corrective surgery is to restore forward gaze and reduce pain