Surgical correction of a rigid sagittal and coronal plane cervical-thoracic deformity

Rigid cervical-thoracic sagittal and coronal plane deformities are uncommon but profoundly debilitating conditions, impairing horizontal gaze and diminishing quality of life. Progressive kyphosis can result from many etiologies, including interbody cage subsidence following anterior cervical discectomy and fusion (ACDF), resulting in loss of anterior column support and eventual fusion in a malaligned position. Surgical correction of these complex deformities requires meticulous planning, and an approach tailored to the severity of the deformity. Posterior-based approaches, including upper thoracic pedicle subtraction osteotomy, can be effective for many fixed cervical-thoracic deformities; however, they may not provide sufficient correction in select cases of severe combined sagittal and coronal malalignment.

We demonstrate a staged surgical approach for correction of a rigid cervical-thoracic deformity. Stage 1 consists of an anterior cervical approach entailing traction, removal of the subsided cages, multilevel corpectomy, and C7/T1 ACDF. Stage 2 utilizes posterior instrumented fusion of C2-L2 with multiple posterior column osteotomies to achieve definitive deformity correction and stabilization.

The presented technique demonstrates how a staged anterior-posterior strategy can achieve correction of severe, rigid deformities that may not be amenable to a posterior-only approach. Careful patient selection and individualized surgical planning remain essential to optimize outcomes.