title: Surgical treatment of neck hyperextension in myopathies.
abstract: Neck hyperextension occurs in relation to several myopathies. It is a progressive increase of lordosis associated with a limitation in flexion of the cervical spine, forcing the patient to assume awkward compensatory postures to maintain balance and level vision. We evaluated operative complications, degree of correction, achievement of a solid arthrodesis, maintenance of the correction, and clinical assessment of seven patients. All had surgery in which the interspinous processes between C2-C7 were opened in a posterior approach and bone graft wedges driven into them to maintain the correction. The mean age of patients at the time of surgical intervention was 16.5 years (range, 10-28 years). The average followup was 10.4 years (range, 2.4-16.5 years). No major surgical complications occurred. After surgery, the average angle between C2-C7 in neutral position had decreased from 50.7 degrees (range, 40 degrees -70 degrees ) to 21.4 (range, 2 degrees -50 degrees ). The range of motion in the C1-C2 joint remained unaffected, whereas it decreased in C2-C7 from 33.5 degrees (range, 15 degrees -64 degrees ) to 1.8 degrees (range, 0 degrees -8 degrees ). A solid arthrodesis was achieved in all patients The followup showed significant clinical improvement of posture in all patients. The operating technique used proved to be safe and effective.
authors.affiliation: Orthopaedic Department, Istituto Ortopedico Rizzoli, Bologna, Italy. giannini@ior.it
authors.forename: Sandro
authors.initials: S
authors.lastname: Giannini
authors.forename: Francesco
authors.initials: F
authors.lastname: Ceccarelli
authors.forename: Cesare
authors.initials: C
authors.lastname: Faldini
authors.forename: Stavroula
authors.initials: S
authors.lastname: Pagkrati
authors.forename: Luciano
authors.initials: L
authors.lastname: Merlini
mesh_terms: D000293:Adolescent; D000328:Adult; D001174:Arthrodesis / Q000379:methods*; D016025:Bone Transplantation / Q000379:methods*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007738:Kyphosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008297:Male; D009135:Muscular Diseases / Q000150:complications* / Q000175:diagnosis; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D014182:Transplantation, Autologous; D016896:Treatment Outcome