title: Mortality and morbidity associated with correction of severe cervical hyperextension.
abstract: METHODS
  Three case reports of patients with treatment of severe cervical hyperextension.
  
  
  OBJECTIVE
  Cervical hyperextension is a rare spine deformity that is associated with myopathies. Previous reports of surgical correction have reported no major operative complications. This report outlines our experience with 3 patients who experienced significant complications.
  
  
  BACKGROUND
  The limited literature on the treatment of cervical hyperextension has good to excellent outcomes.
  
  
  METHODS
  Three case reports are presented.
  
  
  RESULTS
  Three cases with severe cervical hyperextension with intraoperative correction had associated morbidity and mortality. One case had a failed intubation requiring tracheotomy. This was followed by a successful posterior release with halo traction for 2 weeks and then an instrumented posterior cervical fusion. This patient died at home 2 weeks after surgery. The second and third cases had an intraoperative spinal cord injury during a posterior release for cervical hyperextension.
  
  
  CONCLUSIONS
  Patients with severe cervical hyperextension have high neurologic perioperative risk.
authors.affiliation: Department of Orthopedic Surgery, University of California, San Francisco, CA, USA.
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Poulter
authors.forename: Hugh J L
authors.initials: HJ
authors.lastname: Garton
authors.forename: Laurel C
authors.initials: LC
authors.lastname: Blakemore
authors.forename: Robert N
authors.initials: RN
authors.lastname: Hensinger
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Graziano
authors.forename: Frances A
authors.initials: FA
authors.lastname: Farley
mesh_terms: D000293:Adolescent; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D019299:Decompression, Surgical; D017809:Fatal Outcome; D006801:Humans; D007738:Kyphosis / Q000209:etiology / Q000601:surgery; D007796:Laminectomy; D008141:Lordosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D018908:Muscle Weakness / Q000209:etiology / Q000601:surgery; D049288:Muscular Dystrophies, Limb-Girdle / Q000150:complications / Q000601:surgery; D020389:Muscular Dystrophy, Emery-Dreifuss / Q000150:complications / Q000601:surgery; D020512:Myopathy, Central Core / Q000150:complications / Q000601:surgery; D019637:Orthopedic Procedures / Q000009:adverse effects*; D011782:Quadriplegia / Q000209:etiology / Q000601:surgery; D011859:Radiography; D012086:Reoperation; D012720:Severity of Illness Index; D013117:Spinal Cord Compression / Q000209:etiology / Q000601:surgery; D013123:Spinal Fusion / Q000009:adverse effects*; D013130:Spinal Stenosis / Q000209:etiology / Q000601:surgery; D014143:Traction; D016896:Treatment Outcome