Kyphosis, Cervical

H&P

• HPI:
  • Presented to neurosurgery clinic
  • Progressive BUE weakness x6m, right > left
  • History of right hand tendon injury (ulnar side) -> finger deformity and weakness
• PE:
  • Able to stand and achieve good balance in coronal and sagittal planes
  • Head flexed forward
  • Significant varus deformities of both knees
  • Able to toe/heel walk, wide-based gait, unsteady tandem walking
  • -Lhermitte's/Spurling's phenomenon
  • Limited extension with ROM of cervical spine
  • RUE: 2/5 deltoid, otherwise 4/5
  • Diffusely altered sensation to light touch in both hands
  • Grossly intact symmetric strength, BLE
  • Intact sensation to light touch, BLE
  • Hyperreflexia in the legs
  • +Hoffman's, 4-5 beats clonus bilaterally
• Workup: cervical spine CT and MRI, scoliosis X-ray

Imaging

Coronal Cervical Spine MRI - T2WI and T1WI

Standing Scoliosis X-ray, PA and Lateral

Upright Cervical Spine X-ray, PA and Lateral

Cervical Spine CT - Sagittal and Coronal

Surgical Intervention

• Gardner-Wells tongs application and removal (intra-op traction)
• Anterior:
  • C4 corpectomy
  • C3-C5 arthrodesis
• Posterior
  • C2-C7 laminectomies
  • C2-T3 posterolateral fusion

Intra-Operative Fluoroscopy - PA and Lateral

Post-Operative Cervical Spine X-ray - PA and Lateral

Post-Op Recovery

• Admitted to ICU intubated due to concerns of respiratory functions
• Extubated on POD1
• Posterior JP drain removed on POD3
• Improved BUE functions, grossly 4/5 on RUE
• Speech therapy: soft-bite, signed off
• PT: inpatient setting
• Cervical collar

Discussion