title: C7-T1 anterior closing wedge bone-disc-bone osteotomy for the treatment of cervical hyperlordosis in muscular dystrophy: a new technique for correction of a rare deformity.
abstract: METHODS
  A new surgical technique of cervical closing wedge osteotomy to correct an extension deformity of the cervical spine in patients with muscular dystrophy presenting clinically with debilitating hyperlordosis is described, and 3 cases are reported.
  
  
  OBJECTIVE
  To describe a new surgical technique with emphasis on the clinical results and the effect of osteotomy on sagittal balance, gaze angle, and spinopelvic parameters.
  
  
  BACKGROUND
  Previous reports of cervical osteotomy essentially have described opening wedge (extension osteotomy) for correction of severe flexion deformities. To the authors' knowledge, C7-T1 closing wedge osteotomy to correct hyperextension deformity due to muscular dystrophy in the cervical spine has not been described previously.
  
  
  METHODS
  Three male patients aged 16, 16, and 21 years presented with cervical hyperlordosis due to Becker muscular dystrophy. There was upward deviation of forward gaze in all patients. Anterior closing wedge (bone-disc-bone) osteotomy of C7-T1 was performed followed with a posterior release correction and instrumented stabilization. The chin-brow angle was visualized with the aid of fluoroscopy during the operation. After closure and posterior fixation, patient was turned supine again and the osteotomy site was grafted and fixed with a plate to further strengthen the construct and to prevent any translation.
  
  
  RESULTS
  The gaze angles and both sitting and standing postures of the patients markedly improved. There was documented fusion at the osteotomy sites. The patients were free of complaints at the last follow-up.
  
  
  CONCLUSIONS
  Bone-disc-bone closing wedge osteotomy done at C7-T1 level is a technically demanding procedure but results in significant acute clinical and radiological improvement in patients with hyperextension deformity of the cervical spine.
  
  
  METHODS
  4.
authors.affiliation: *Faculty of Medicine, Department of Orthopedics and Traumatology, Marmara University, Istanbul, Turkey †Faculty of Medicine, Department of Orthopedics and Traumatology, Sakarya University, Sakarya, Turkey ‡Department of Orthopedics and Traumatology, Bahcelievler Devlet Hst §Faculty of Medicine, Department of Orthopedics and Traumatology, Bolu Abant Izzet Baysal University, Bolu, Turkey.
authors.forename: Kamil Cagri
authors.initials: KC
authors.lastname: Kose
authors.forename: Islam
authors.initials: I
authors.lastname: Caliskan
authors.forename: Emre
authors.initials: E
authors.lastname: Bal
authors.forename: Mustafa Erkan
authors.initials: ME
authors.lastname: Inanmaz
authors.forename: Cengiz
authors.initials: C
authors.lastname: Isik
mesh_terms: D000293:Adolescent; D002574:Cervical Vertebrae / Q000601:surgery*; D005471:Fluoroscopy; D006801:Humans; D008141:Lordosis / Q000209:etiology / Q000601:surgery*; D008297:Male; D020388:Muscular Dystrophy, Duchenne / Q000150:complications*; D010027:Osteotomy / Q000379:methods*; D013904:Thoracic Vertebrae / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult