title: Five-level cervical corpectomy for neurofibromatosis-associated spinal deformity: case report.
abstract: OBJECTIVE
  To describe a successful five-level cervical corpectomy and circumferential reconstruction in a patient with a plexiform neurofibroma causing a severe kyphotic deformity.
  
  
  METHODS
  Case report.
  
  
  RESULTS
  43-year-old man with history of Neurofibromatosis presented with signs and symptoms of myelopathy with spastic lower extremities and gait difficulties. Imaging studies demonstrated a severe kyphotic deformity of the cervical spine with associated cord compression secondary to an anteriorly positioned plexiform neurofibroma. Two-stage surgical procedure was designed to treat this lesion. Stage I consisted of tracheostomy placement, transmandibular, circumglossal approach to the anterior cervical spine, C2-C6 corpectomies, and C1-C7 reconstruction with a custom titanium cage/plate. Stage II consisted of suboccipital craniectomy, C1-C2 laminectomies, and occipital-cervical thoracic instrumented fusion (O-T8). There were no operative complications, but the patient did develop a small pulmonary embolism post-operatively treated with anticoagulation. Patient required two-weeks of inpatient rehabilitation following surgery. Gastrostomy tube and tracheostomy were successfully discontinued with preserved swallowing and respiratory function. Patient-reported outcome measurements revealed significant and sustained improvement post-operatively.
  
  
  CONCLUSIONS
  Five-level cervical corpectomy including C2 can be safely and successfully performed via a transmandibular, circumglossal approach. Circumferential reconstruction utilizing a custom anterior titanium cage and plate system manufactured from a pre-operative CT scan was utilized in this case. Long segment occipital-cervical-thoracic reconstruction is recommended in such a case. Using such a technique, improvement in myelopathy, correction of deformity, and improved quality of life can be achieved.
authors.affiliation: Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA, slparker7@gmail.com.
authors.forename: Scott L
authors.initials: SL
authors.lastname: Parker
authors.forename: Jean Paul
authors.initials: JP
authors.lastname: Wolinsky
authors.forename: Anthony P
authors.initials: AP
authors.lastname: Tufaro
authors.forename: Ziya L
authors.initials: ZL
authors.lastname: Gokaslan
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Witham
mesh_terms: D000328:Adult; D001860:Bone Plates; D002574:Cervical Vertebrae / Q000601:surgery*; D006258:Head and Neck Neoplasms / Q000150:complications* / Q000601:surgery; D006801:Humans; D007738:Kyphosis / Q000209:etiology / Q000601:surgery*; D008297:Male; D018318:Neurofibroma, Plexiform / Q000150:complications* / Q000601:surgery; D009456:Neurofibromatosis 1 / Q000150:complications* / Q000601:surgery; D019637:Orthopedic Procedures / Q000295:instrumentation / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods*; D013117:Spinal Cord Compression / Q000209:etiology / Q000601:surgery