title: Five-level sub-axial cervical vertebrectomy and reconstruction: technical report.
abstract: OBJECTIVE
  Regardless of the etiology, severe cervical deformities can be extremely debilitating and are a challenge to correct. Often a multi-modality team approach is required to safely and effectively reduce the deformity, provide adequate decompression, and ensure solid fixation and fusion. In cases of iatrogenic cervical deformity necessitating five-level corpectomy and fixation, the feasibility, safety, and durability of this procedure remains unknown.
  
  
  RESULTS
  We describe a patient who presented with debilitating pain and inability to eat due to an iatrogenic chin-on-chest cervical kyphotic deformity. The patient underwent a back-front-back staged procedure requiring five-level cervical vertebrectomy, C3-T1 anterior fixation, and occipital to T5 posterior fusion, resulting in successful reduction of cervical kyphosis from 75 to 0 degrees. At 6 months post-operatively, the patient demonstrated marked improvement in neurologic function and reported substantial improvements in neck pain-specific disability (NDI) and quality of life (SF-12 and EQ-5D).
  
  
  CONCLUSIONS
  The feasibility and safety of five-level vertebrectomy and reconstruction for chin-on-chest deformity remains poorly described. The current case suggests that thoughtful planning that involves maximizing the patient's health status, judicious use of traction under direct neurological examination, staged circumferential release, and design of a construct that provides anterior and posterior column support with several points of fixation beyond the axis of rotation will attenuate the risk of peri-operative morbidity and potentiate the durability of deformity correction.
authors.affiliation: Department of Neurological Surgery, Vanderbilt University Medical Center, T4224 MCN, Nashville, 37232-2380, TN, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Reig
authors.forename: Scott L
authors.initials: SL
authors.lastname: Parker
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: McGirt
mesh_terms: D002574:Cervical Vertebrae / Q000601:surgery*; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000209:etiology / Q000601:surgery; D011788:Quality of Life; D013123:Spinal Fusion; D013904:Thoracic Vertebrae / Q000601:surgery*; D014143:Traction; D064232:Visual Analog Scale