gms | German Medical Science

Objectives: To evaluate the safety and effectiveness of one-stage posterior cervical osteotomy for stiff cervical spine deformity (CSD), and to explore the indications and key techniques of one-stage posterior cervical osteotomy and instrumentation for the treatment of stiff CSD.

Methods: From June 2012 to June 2023, 12 CSD patients were admitted, including 5 males and 7 females. The age is 7–46 years old, with an average of (34.2±7.8) years old. Among all the patients, there were 5 cases of congenital CSD, 3 cases of tuberculous CSD, 3 cases of ankylosing spondylitis combined with CSD, and 1 case of iatrogenic CSD. All patients underwent one-stage posterior approach corrective osteotomy and internal fixation surgery. The neurological function was evaluated using the Japanese Orthopaedic Association Scores (JOA) before operation, after operation, and at the last follow-up.

Results: The operation time was 90–240 minutes, with an average of 165 minutes. The bleeding volume is 150–350 ml, with an average of 175 ml. The postoperative JOA score was 13–16 points, with an average of 15.20 points and an improvement rate of 77.2%. Osteotomy position: C2, C6, T2: 1 case; C3, C4, C7: 2 cases; T1: 3 cases; C5: 4 cases. Seven cases were intercepted by Pedicle Subtraction Osteotomy (PSO) and nine cases were intercepted by Vertebral Column Resection (VCR). The upper instrumented vertebra (UIV) in occipital region: 3 cases. The lower instrumented vertebra (LIV) in upper thoracic vertebrae: 6 cases. UIV-LIV in cervical spine: 3 cases. The preoperative coronal Cobb angle was 34.1°±10.0°. The postoperative improvement was 11.6°±4.1°. The preoperative Cobb angle in the sagittal plane was 57.1°±9.8°. The postoperative improvement was 16.7°±3.6°. The transient nerve injury occurred in 4 cases. There is 1 case of occlusion of the central retinal artery. Additionally, 1 case occurred vertebral artery injury.

Conclusion: This study is the first to report on the treatment of stiff CSD caused by various causes above C7 with one-stage posterior osteotomy and correction, proving that it is safe and effective and can achieve or be better than the efficacy of 360° or 540° combined cervical spine osteotomy and correction. Standard PSO and modified techniques can be used for patients with predominant cervical kyphosis, while hemivertebral resection and concave side distraction technique or APSO is suitable for congenital cervical scoliosis or kyphosis. Osteotomy and orthopedic treatment of stiff CSD requires VA exposure or exclusion techniques to perform osteotomy and orthopedic surgery under the protection of clearly exposed adnexal structures and VA confirmation, and does not require extensive bone tissue resection of the diseased segment. Neurovascular injury remains a serious and common complication. Careful preoperative assessment, meticulous intraoperative operation, appropriate osteotomy techniques, and prevention of complications are the keys to ensuring successful surgery.