Adopting 540-degree fusion to correct cervical kyphosis

Two cases of severe cervical spine kyphotic deformity resulting from late effects of infection were successfully corrected by combined anterior and posterior instrumentations in a single operative sitting.

Case 1 is a 43-year-old man who developed severe cervical kyphosis from C5-6 discitis over a few months despite long-term antibiotic therapy. He was neurologically intact except for severe neck pain and obvious deformity. Case 2 is a 40-year-old woman who had a previous wound infection five years before presentation. There was gradual worsening of swan neck deformity at the C2-3 and C5-6 levels with some spinal cord compression worsening her baseline myelopathy. The patients were placed and maintained in cervical traction on the Stryker frame for the duration of the procedure. Both cases required anterior approach initially to achieve some release of dense scar tissue using a high-speed drill. The wounds were then closed and patients were rotated to the prone position for further release of fused bony elements, including the facets. Lateral mass screws and plates were placed. In Case 2, additional instrument to the occipital was performed to stabilize the C2 using a U-shaped cervical rod. Once adequate reduction had been achieved, the patients were rotated back to supine position for further corpectomy and fibular construct fusion with plates.

In cases of severe kyphotic deformity complicating infectious vertebral destruction, the spinal alignment can be achieved safely by a multi-step technique combining the anterior as well as posterior surgical approaches.