Surgical management of pediatric cervical angular kyphosis with 540° approach and metacarpal plate: A case report and introduction of a novel technique

Mohammad Zarei; Mersad Moosavi; Nima Rahimi; Mohsen Rostami

doi:10.4103/ajns.AJNS_195_20

Asian Journal of Neurosurgery, Table of Contents

CC BY-NC-ND 4.0 · Asian J Neurosurg 2021; 16(01): 155-158
DOI: 10.4103/ajns.AJNS_195_20

Case Report

Surgical management of pediatric cervical angular kyphosis with 540° approach and metacarpal plate: A case report and introduction of a novel technique

Mohammad Zarei

Department of Orthopedic Surgery, Tehran University of Medical Sciences, Tehran

,

Mersad Moosavi

¹Spine Center of Excellence, Yas Hospital, Tehran University of Medical Sciences, Tehran

,

Nima Rahimi

²Department of Neurosurgery, Tehran University of Medical Sciences, Tehran

,

Mohsen Rostami

³Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran

› Author Affiliations

Abstract

Surgical decompression, deformity correction, and instrumentation of the upper cervical spine are challenging problems in cervical kyphosis, especially in infants and pediatrics. According to patients' age, surgical exposure is difficult and selecting the appropriate instrument for rigid fixation is crucial. In this article, we present a case of 2 years old with cervical angular kyphosis, which was approached posteriorly at first. Through posterior approach, C3–C5 laminectomy with complete excision of spinous process was performed. Then, the patient's position was changed to supine and C3–C5 corpectomies were performed anteriorly with a longitudinal incision, and the thecal sac was decompressed. A titanium cage with appropriate size and graft was placed after possible deformity correction conducted with head traction and neck extension. Anterior fixation was performed with two, 2-mm T-shaped metacarpal plates with two screws in C2 and four screws in C6. The patient's position was changed to prone again, and posterior fixation was done with two metacarpal plates located on lateral masses. We showed that a novel technique in correction and fixation of cervical kyphosis in pediatric is using metacarpal plates while they are fixed to lateral masses.

Key-words:

Cervical fusion - cervical kyphosis - pediatric spine

Full Text

References

References
1 Forese LL, Berdon WE, Harcke HT, Wagner ML, Lachman R, Chorney GS, et al. Severe mid-cervical kyphosis with cord compression in Larsen's syndrome and diastrophic dysplasia: Unrelated syndromes with similar radiologic findings and neurosurgical implications. Pediatr Radiol 1995;25:136-9.
2 Johnston CE 2nd, Birch JG, Daniels JL. Cervical kyphosis in patients who have Larsen syndrome. J Bone Joint Surg Am 1996;78:538-45.
3 Poussa M, Merikanto J, Ryöppy S, Marttinen E, Kaitila I. The spine in diastrophic dysplasia. Spine (Phila Pa 1976) 1991;16:881-7.
4 Remes V, Marttinen E, Poussa M, Kaitila I, Peltonen J. Cervical kyphosis in diastrophic dysplasia. Spine (Phila Pa 1976) 1999;24:1990-5.
5 Svensson O, Aaro S. Cervical instability in skeletal dysplasia. Report of 6 surgically fused cases. Acta Orthop Scand 1988;59:66-70.
6 Coscia MF, Bassett GS, Bowen JR, Ogilvie JW, Winter RB, Simonton SC. Spinal abnormalities in camptomelic dysplasia. J Pediatr Orthop 1989;9:6-14.
7 Jasiewicz B, Potaczek T, Tesiorowski M, Lokas K. Spine deformities in patients with Ehlers-Danlos syndrome, type IV-late results of surgical treatment. Scoliosis 2010;5:26.
8 McMaster MJ. Spinal deformity in Ehlers-Danlos syndrome. Five patients treated by spinal fusion. J Bone Joint Surg Br 1994;76:773-7.
9 Mummaneni PV, Dhall SS, Rodts GE, Haid RW. Circumferential fusion for cervical kyphotic deformity. J Neurosurg Spine 2008;9:515-21.
10 Nottmeier EW, Deen HG, Patel N, Birch B. Cervical kyphotic deformity correction using 360-degree reconstruction. J Spinal Disord Tech 2009;22:385-91.
11 Kokubun S, Ozawa H, Sakurai M, Ishii Y. One-stage anterior and posterior correction of severe kyphosis of the cervical spine in neurofibromatosis. A case report. Spine (Phila Pa 1976) 1993;18:2332-5.
12 Francis WR Jr., Noble DP. Treatment of cervical kyphosis in children. Spine (Phila Pa 1976) 1988;13:883-7.
13 Martus JE, Griffith TE, Dear JC, Rathjen KE. Pediatric cervical kyphosis: A comparison of arthrodesis techniques. Spine (Phila Pa 1976) 2011;36:E1145-53.
14 Sakaura H, Matsuoka T, Iwasaki M, Yonenobu K, Yoshikawa H. Surgical treatment of cervical kyphosis in Larsen syndrome: Report of 3 cases and review of the literature. Spine (Phila Pa 1976) 2007;32:E39-44.