Pedicle Subtraction Osteotomy for Deformity Correction in the Upper Cervical Spine: A Technical Note

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Spinal Deformity Correction

Background:

• Cervical kyphosis is a common spinal deformity causing severe disability.
• Fused kyphosis often necessitates complex, multi-step surgical interventions.
• This study introduces a single-stage pedicle subtraction osteotomy (PSO) technique for C3 to address fused C2-C3 kyphosis.

Observation:

• A 53-year-old male presented with progressive myelopathy and inability to walk, secondary to severe cervical kyphosis.
• Imaging revealed fused C2-C3 kyphosis causing spinal stenosis, cord compression, and loss of horizontal gaze.
• Computed tomography confirmed significant anterior and posterior fusion at C2 and C3.

Findings:

• The surgical procedure involved laminectomy (C2-C6), PSO of C3, and dorsal instrumentation (C2-C6).
• Post-operative imaging showed successful correction of cervical alignment (Cobb angle reduced from 48.9° to 20.6°).
• The patient experienced neurological recovery, regained ambulation, and restored horizontal gaze without complications.

Implications:

• Single-stage PSO is a viable surgical option for selected severe, fused cervical kyphosis cases.
• This approach may reduce operative time and potential complications compared to multi-stage procedures.
• Effective management of cervical kyphosis can significantly improve patient function and quality of life.