Surgical treatment of severe deformities of cervico-thoracic junction

Abstract

In this study, the outcomes of surgical treatment of severe spinal cervico-thoracic deformities are evaluated. An analysis of 8 patients who underwent surgery between 2012 and 2015 is presented. Mean age was 11,2 years (range from 2 to 18 y.o.). In 6 patients KFS with cervico-thoracic kyphosis was observed. In 2 patients, both 2-year-old girls, there was anterior displacement at the Th1 vertebra, most likely due to congenital dislocation. In 2 cases type I neurofibromatosis was observed. All the patients with KFS presented with neurological deficit: four patients presented with inferior paraparesis and two patients – with tetraparesis due to cervical myelopathy. In all cases staged surgical treatment was performed: halo-traction for 10-14 days, then occipito-cervico-thoracic instrumented fixation as the 2nd stage. In one case, anterior cervical multilevel fusion with autografting was performed as the 3rd stage. In all but one patient full-scale 3D models of the vertebral column at the deformity level was manufactured based on CT-scans. Mean follow-up time was 18,8 months (range 12-36). In all cases, sufficient correction was achieved. In two cases, there was improvement in neurological status. In two cases fractures of one of the 2,5 mm rods in occipito-cervical instrumentation were observed. This condition requires reoperation and additional reinforcing occipito-cervical fixation using cortical peroneal autograft. Conclusion. Due to the severity and complexity of congenital deformities of the cervico-thoracic junction, full-scale 3-D models are indispensable for understanding anatomical relationships and for surgery planning. Halo-traction is recommended for preoperative correction and neurological complication prevention.