Surgical management of congenital C2 over C3 spondyloptosis with severe cervical kyphosis: two case reports

This study aims to report the surgical management and outcomes of two rare cases of congenital C2 over C3 spondyloptosis with severe cervical kyphosis (CK) caused by bilateral axial appendage abnormalities, providing insights into individualized surgical strategies for this complex condition.

Two patients with distinct clinical presentations were included. Case 1: A 4-year-old girl with progressive CK and limb weakness underwent anterior cervical discectomy, C3 corpectomy, and fusion via a submandibular approach using autologous iliac bone grafting and customized plate fixation. Case 2: A 16-year-old female with recurrent C2 over C3 spondyloptosis after failed prior surgery underwent anterior revision (transoral approach) with C2/4 fusion and posterior occipitocervical fusion. Preoperative/postoperative clinical, radiographic, and neurological outcomes were analyzed.

Both patients achieved significant kyphosis correction (Case 1: 88° to 11°; Case 2: 63° to 8°), adequate spinal cord decompression, and neurological recovery (Case 1: ASIA grade B to E; Case 2: ASIA grade C to E). Postoperative imaging confirmed stable fixation and bony fusion. No complications occurred during a follow-up of 5 years.

Congenital C2 over C3 spondyloptosis with CK requires tailored surgical approaches based on age, anatomical anomalies, and prior interventions. Anterior or combined anterior-posterior strategies effectively restore stability, correct deformity, and relieve neurological deficits. Long-term monitoring is essential, particularly in pediatric patients, to address growth-related challenges.