title: Severe cervical kyphotic deformity caused by postural disorders in a child with schizophrenia.
abstract: BACKGROUND
  Although severe cervical kyphotic deformity results from a number of causes, the psychiatric disease itself did not play a metabolic role in the development of the deformity. However, we diagnosed a case of cervical deformity caused by postural disorders associated with schizophrenia.
  
  
  OBJECTIVE
  The purpose of this case report is to describe a rare episode in a schizophrenic patient with a fixed cervical flexion deformity caused by postural disorders.
  
  
  METHODS
  A case report.
  
  
  METHODS
  An 18-year-old woman with a history of schizophrenia and a persistent behavioral cervical flexion posture presented for evaluation. At the initial examination, a significant fixed cervical flexion measuring 100° was noted. Her chin was in contact with her manubrium, and left scars developed on both her chin and manubrium. She had hyperreflexia in all extremities but no further neurologic deficits, although her initial magnetic resonance imaging (MRI) indicated multilevel cervical cord compression.
  
  
  METHODS
  She was initially treated conservatively but had a progression in fixed cervical flexion positioning. She complained of a persistent inability to ambulate within the community, as she was unable to bring her head into a neutral position to be able to see objects in her path. She also complained of inability to drink from a water bottle as she had difficulty depressing her mandible. The patient and her family requested a surgical correction. Although she had no significant clinical neurologic deficit, she did have significant MRI findings and limitation of functional activities. We felt her limitations were significant enough to warrant surgical correction.
  
  
  RESULTS
  A combined anterior and posterior procedure was performed resulting in an improved cervical head posture. She was able to return to community activities and resume drinking from a water bottle.
  
  
  CONCLUSIONS
  Although this technique has been well described previously, this is the first report of a rare episode in a schizophrenic patient with severe cervical kyphosis deformity because of a constant neck flexion posture.
authors.affiliation: Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa 252-0374, Japan.
authors.forename: Wataru
authors.initials: W
authors.lastname: Saito
authors.forename: Takayuki
authors.initials: T
authors.lastname: Imura
authors.forename: Masaki
authors.initials: M
authors.lastname: Ueno
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Nakazawa
authors.forename: Naonobu
authors.initials: N
authors.lastname: Takahira
authors.forename: Masashi
authors.initials: M
authors.lastname: Takaso
mesh_terms: D000293:Adolescent; D002574:Cervical Vertebrae / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D011187:Posture / Q000502:physiology*; D016059:Range of Motion, Articular / Q000502:physiology; D012559:Schizophrenia / Q000150:complications* / Q000503:physiopathology / Q000601:surgery
keywords: Cervical deformity; Kyphosis; Postural disorder; Schizophrenia; Spinal deformity