Anterior Fibular Graft and Posterior Fusion for Proximal Cervical Kyphosis Following Resection of Posterior Fossa...

A 4-year-old boy with a history of posterior fossa ependymoma resection and radiation treatment developed postlaminectomy kyphosis at the occipito-cervical junction. Cervical radiographs showed 46° kyphosis between C2 and C4. A 3-stage surgical approach was done: halo-gravity traction, anterior C2 to C4 fusion with a fibular allograft, and posterior occiput-C4 instrumented fusion. Halo traction reduced kyphosis by over 50%. At 1-year follow-up, the patient showed stable fixation and successful fusion with modest limitation in cervical motion.

The approach effectively corrected the deformity and successfully achieved fusion despite previous radiation treatment and bone deficiency in a very young, skeletally immature patient.