title: Severe fixed cervical kyphosis treated with circumferential osteotomy and pedicle screw fixation using an anterior-posterior-anterior surgical sequence.
abstract: BACKGROUND
  Surgical treatment for severe circumferentially fixed cervical kyphosis has been challenging. Both anterior and posterior releases are necessary to provide the cervical mobility necessary for fusion in a corrected position.
  
  
  OBJECTIVE
  In two case reports, we describe the circumferential osteotomy of anterior-posterior-anterior surgical sequence, and the efficacy of this technique when cervical pedicle screw fixation for severe fixed cervical kyphosis is used.
  
  
  METHODS
  Etiology of fixed cervical kyphosis was unknown in one patient and neurofibromatosis in one patient. Both patients had severe fixed cervical kyphosis as determined by cervical radiographs and underwent circumferential osteotomy and fixation via an anterior-posterior-anterior surgical sequence and correction of kyphosis by pedicle screw fixation.
  
  
  CONCLUSIONS
  Severe fixed cervical kyphosis was treated successfully by the use of circumferential osteotomy and pedicle screw fixation. The surgical sequence described in this report is a reasonable approach for severe circumferentially fixed cervical kyphosis and short segment fixation can be achieved using pedicle screws.
authors: Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan. Electronic address: hiroyoshihara55@yahoo.co.jp.
authors: Hiroyuki
authors: H
authors: Yoshihara
authors: Kuniyoshi
authors: K
authors: Abumi
authors: Manabu
authors: M
authors: Ito
authors: Yoshihisa
authors: Y
authors: Kotani
authors: Hideki
authors: H
authors: Sudo
authors: Masahiko
authors: M
authors: Takahata
mesh_terms: D000328:Adult; D001863:Bone Screws; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007738:Kyphosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000000981:diagnostic imaging / Q000601:surgery; D017253:Neurofibromatoses / Q000150:complications; D010027:Osteotomy / Q000379:methods*; D011859:Radiography; D012720:Severity of Illness Index; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*
keywords: Anterior-posterior-anterior; CT; Cervical spine; Circumferential osteotomy; Computed tomography; Fixed cervical kyphosis; JOA; Japanese Association Score; MRI; Magnetic resonance imaging; Pedicle screw fixation