The "Rail Technique" for Correction of Cervicothoracic Kyphosis: Case Report and Surgical Technique Description

Cervicothoracic deformity correction often necessitates a shortening operation, consisting of a 3-column osteotomy (3CO). While effective, segmental compression and in situ and cantilever bending often place screws under considerable stress and may jeopardize deformity correction. In this report, we present the surgical technique of a novel method, the "rail technique," to shorten across a vertebral column resection (VCR) for cervicothoracic deformity correction. A 65-year-old woman with a history of a C5-pelvis posterior instrumented fusion (PSIF) presented with chin-on-chest deformity after a prior proximal junctional failure/kyphosis at T4 (30° T3-5) above a prior T5-pelvis PSIF that was stabilized in situ. She underwent an uncomplicated revision C2-T10 PSIF with shortening across a T4 VCR using the "rail technique." Postoperatively, radiographs demonstrated excellent restoration of and normalization of cervical sagittal alignment, thoracic kyphosis, focal T3-5 kyphosis (7°), and global sagittal alignment. At 1-year postoperation, she was without neck pain and reported significant improvements in self-image, mental health, satisfaction, and subscale Scoliosis Research Society-22 scores compared to preoperative values. The "rail technique" is a safe and effective method for shortening over a 3CO to correct the cervicothoracic deformity.