• Xinghai Yang, Shaohui He, Jian Yang, Dongyu Peng, Jian Jiao, Chen Ye, Haifeng Wei, and Jianru Xiao.
• Spinal Tumor Center, Department of Orthopaedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China.
• World Neurosurg. 2018 Nov 1; 119: 45-51.

ObjectiveOsteotomy through anterior exposure is challenging with severe complications for upper cervical kyphosis (CK), especially for cases with previous anterior fusion. A novel technique comprising 1-stage osteotomy via a posterolateral-only approach is introduced for treatment of CK secondary to C2-4 laminectomy for neurofibroma removal and subsequent anterior fusion.MethodsA 42-year-old man presented with progressive numbness and weakness of upper and lower limbs. As an adolescent, he underwent posterior laminectomy and neurofibroma excision without effective fixation and anterior C2-4 vertebra fusion 6 years later. Sagittal computed tomography indicated that Cobb angle between C2 and C6 was 68° with complete fusion between C2 and C4 vertebral bodies. Secondary CK was diagnosed based on medical history and radiographic findings, and modified Japanese Orthopaedic Association scale score was 10. Piezosurgery was used for osteotomy by shortening the vertebral height through posterolateral approach after cervical pedicle screw placement. Occipitocervical fusion was performed with compression between C2 and C4.ResultsCobb angle was adjusted to 8° postoperatively. Modified Japanese Orthopaedic Association score increased to 14 with obvious muscle strength improvement. The 6-month postoperative x-ray indicated good position of C2-4 vertebrae and occipitocervical fixation system. No neurologic complications or local recurrence was found at final follow-up at 8 months. The patient returned to work in his full capacity.ConclusionsPreliminary outcomes reveal wedge osteotomy via piezosurgery through a posterolateral-only approach is feasible and effective in revision surgery for upper CK with previous anterior fusion.Copyright © 2018 Elsevier Inc. All rights reserved.

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