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Mortality and morbidity associated with correction of severe cervical hyperextension
Gregory T Poulter1, Hugh J L Garton, Laurel C Blakemore
1Department of Orthopedic Surgery, University of California, San Francisco, CA, USA.
Insights
Severe cervical hyperextension surgery carries significant risks, unlike previous reports. This case series highlights high neurologic perioperative risks and complications in patients undergoing treatment for this rare spine deformity.
Area of Science:
- Spine Surgery
- Neurology
- Orthopedics
Background:
- Cervical hyperextension is a rare spinal deformity linked to myopathies.
- Limited literature suggests good to excellent outcomes for surgical correction.
- Previous reports indicated no major operative complications.
Observation:
- This report details three cases of severe cervical hyperextension.
- Patients underwent surgical correction with associated complications.
- Complications included failed intubation, tracheotomy, and intraoperative spinal cord injury.
Findings:
- One patient experienced a failed intubation requiring tracheotomy, followed by posterior release, halo traction, and fusion, but later died.
- Two patients sustained intraoperative spinal cord injuries during posterior release.
- These cases demonstrate significant morbidity and mortality associated with surgical intervention.
Implications:
- Patients with severe cervical hyperextension face high neurologic perioperative risks.
- Surgical outcomes may differ from previous reports, necessitating careful patient selection and risk assessment.
- Further research is needed to understand and mitigate these risks.
Study Design:
Three case reports of patients with treatment of severe cervical hyperextension.
Objective:
Cervical hyperextension is a rare spine deformity that is associated with myopathies. Previous reports of surgical correction have reported no major operative complications. This report outlines our experience with 3 patients who experienced significant complications.
Summary Of Background Data:
The limited literature on the treatment of cervical hyperextension has good to excellent outcomes.
Methods:
Three case reports are presented.
Results:
Three cases with severe cervical hyperextension with intraoperative correction had associated morbidity and mortality. One case had a failed intubation requiring tracheotomy. This was followed by a successful posterior release with halo traction for 2 weeks and then an instrumented posterior cervical fusion. This patient died at home 2 weeks after surgery. The second and third cases had an intraoperative spinal cord injury during a posterior release for cervical hyperextension.
Conclusion:
Patients with severe cervical hyperextension have high neurologic perioperative risk.
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