Medical Student Department of Neurosurgery, University of Illinois at Chicago Chicago, IL, US
Introduction: A 66-year-old male presented with debilitating chronic cervical kyphosis causing neck pain and myelopathy. Cervical spine imaging showed autofusion of C3 through C7 anteriorly and focal kyphosis with a tortuous left vertebral artery following the kyphotic deformity. A two-stage anterior C7 corpectomy with cage placement and posterior occiput-T4 fusion was planned.
Methods: The patient was positioned supine, prepared, and incision was made to the platysma. Dissection with hemostasis and retraction was performed to reach the level of the precervical fascia. Caspar pins were placed at T1 and C6 and confirmed with fluoroscopy. A C7 corpectomy followed by discectomies at C5-6 and C7-T1 with endplate preparation were performed. The posterior longitudinal ligament was transected and thecal sac was visualized bilaterally, followed by lateral resection visualizing the foramen transversarium and lateral component of the vertebral body. The nerve roots of C7 and C8 were skeletonized, allowing visualization of the vertebral body while drilling through the foramen transversarium. The thecal sac, bilateral vertebral arteries, and the C7 and C8 exiting nerve roots were identified. Decompression was confirmed with intraoperative CT, and a corpectomy cage was placed at the space of C7 between C6 and T1. The anterior wound was closed to prepare for stage two and all instruments were kept sterile during the transition.
The patient was positioned on a Jackson table in a Mayfield skull clamp, turned prone, and prepared. Dissection with hemostasis and retraction was performed to visualize from occiput to the T4 lamina, spinous process, and facets. Lateral mass screws were placed from C3 to C6 using standard Roy-Camille technique, and pedicle screws were placed from T1 through T4. An en-bloc C7 posterior column osteotomy was performed using a high-speed drill. Finally, an occipital plate was placed, and hardware placement was confirmed with intraoperative CT. The posterior wound was closed, concluding the procedure.
Results: Postoperative CT showed significant improvement in the degree of cervical kyphosis. The patient had full upper extremity strength postoperatively and was discharged to home without complication.
Conclusion : 7 vertebrectomy and fusion with vertebral artery mobilization is a viable treatment for chronic cervical kyphosis causing compression of the vertebral artery.
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