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Upper Thoracic Vertebral Column Resection for Progressive Cervical Deformity

February 10, 2018

Contributors: Amos Dai, BS; Dylan Lowe, MD; Kartik Shenoy, MD; Michael L Smith, MD; Themistocles Stavros Protopsaltis, MD; Themistocles Stavros Protopsaltis, MD

2018 HONORABLE MENTION Purpose: Vertebral column resection (VCR) is the most powerful deformity correction tool in the spine surgeon’s armamentarium. Originally described in 1922 by MacLennan, the technique has evolved from a combined anterior-posterior staged procedure to a single-stage posterior only technique (if applicable). VCR may be indicated in patients with a severe, rigid spinal deformity in whom traditional osteotomy cannot afford adequate correction without complications. The posterior technique was popularized by Suk, who first performed the technique in 2002. Since then, 17 major studies have been published on the outcomes of VCR. This video discusses the case presentation of a patient in whom proximal junctional kyphosis developed after T4 VCR and T1 through T10 instrumented fusion. The patient subsequently underwent a second VCR at T2, with extension of the fusion construct to restore sagittal alignment. Methods: This video discusses the case presentation of a 57-year-old woman who underwent scoliosis correction with the use of Harrington rods as a child. She initially presented with severe neck pain with radiation to her forearms bilaterally and intermittent numbness in her hands bilaterally. She was indicated for a T4 VCR and posterior spinal fusion from T1 through T10. Postoperatively, the patient did well; however, after several months, she began to feel as if her head was falling forward and that her head felt heavy by the end of the day. She was unable to perform a horizontal gaze. Nonsurgical treatment, including physical therapy and bracing, failed in this patient. A T2 VCR and posterior spinal fusion from C2 through T3 with instrumentation from C2 through T10 was indicated. The video reviews the patient's preoperative history and imaging studies and demonstrates the technique for performing a posterior VCR. Results: The patient's postoperative imaging studies revealed adequate restoration of sagittal balance. The patient reported that she and her family notice considerable improvement in her clinical alignment. She is able to stand upright and perform a horizontal gaze. On physical examination, she has full strength and sensation throughout. Conclusion: VCR is a powerful tool for correcting severe, rigid spinal deformity in patients in whom corrective osteotomy will not suffice. Our patient’s proximal junctional kyphosis was corrected via a VCR, which allowed her to stand upright and improved her clinical alignment.

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