Circumferential fusion for severe post surgical cervical kyphosis

Cervical kyphosis-though a common occurrence after surgery and other conditions like trauma, infections, etc., is usually restricted to around 20-40°. It is more common in children. Angulations of more than 70-80° are exceedingly uncommon and present more treatment challenges. We discuss here the management of a 14-year-old child with a severe postoperative cervical kyphotic angulation of 92°. The child presented 10 months after surgery for a C3-C4 intramedullary cyst with neck deformity and near tetraplegic state. He underwent a combined anterior-posterior approach for correction after a trial of skull traction. Six months after the surgery, the child was ambulatory with almost total correction of the deformity. Surgical correction of postoperative cervical kyphosis usually involves a posterior approach for small angles and an anterior approach for larger angulations. The combined anterior-posterior approach is preferred for severe angulations or for those cases not correctable by a single approach. A purely posterior approach may be the only option for those cases where the anterior approach is impossible.