Progressive neck deformation after intramedular cervical tumor removal by laminoplasty approach

Abstract

Posterior approaches are usually used for the removal of tumors localized in the spinal canal, employing laminectomy techniques with the possibility of subsequent laminoplasty. However, even when bone defects are replaced with autografts, studies have shown a high likelihood of postoperative deformities, particularly in cases involving multisegment laminoplasty and radiotherapy. This risk increases with multisegmented laminoplasty and subsequent radiotherapy exposure. This study presents a clinical case of treating a patient with an intramedullary tumor from C2-Th1 after surgery using the laminoplasty technique, followed by adjuvant radiotherapy. After treatment, the patient developed pathological kyphosis of the cervical spine, with a Cobb angle of 82°. A comprehensive treatment approach was employed, which included fixation and traction in a HALO-vest apparatus, followed by anterior corporodesis and posterior occipitospinal fusion to achieve satisfactory correction and prevent further deformities and secondary spinal cord injuries. Deformities are a common complication of laminoplasty without additional stabilization. The contributing factors include the use of multilevel approaches, adjuvant radiotherapy, and pre-existing segmental instability. Careful planning is required to prevent pathological kyphosis and secondary spinal cord injury. This planning should consider the volume of bone defects, fixation techniques, subsequent treatment, initial range of motion, and type of primary physiological curvature.