Laryngo-pharyngeal-vertebral extirpation: a radical multidisciplinary surgical approach to managing complications from oropharyngeal squamous cell carcinoma treatment. Illustrative case.

Background: A 76-year-old female presented with rigid cervical sagittal plane deformity, myelopathy, chronic aspiration, and dysphonia. This was complicated by a past medical history of partial laryngectomy and neck irradiation for oropharyngeal squamous cell carcinoma. Severe rigid cervical kyphosis resulted in impaired horizontal gaze and progressive myelopathy. She had worsening chronic aspiration and dysphonia secondary to an esophageal fistula into the prevertebral space.

Observations: The authors performed a two-stage, multidisciplinary surgery combining neurosurgical and otolaryngological expertise. Stage 1 involved anterior neck exposure, laryngopharyngectomy with pectoralis major myocutaneous conduit reconstruction, C3-6 corpectomy, anterior column reconstruction, and C2-7 anterior fixation and fusion. Stage 2 entailed posterior instrumented fusion from C1 to T3. Postoperatively, the patient experienced significant clinical improvement and symptom resolution. Follow-up imaging at 18 months confirmed maintenance of sagittal plane correction.

Lessons: This case highlights the value gained from multidisciplinary collaboration in complex cervical deformity management. Despite the patient's "rigid" deformity on CT, intraoperative traction proved valuable to achieve sagittal plane correction, which optimized the anterior neck corridor for the ear, nose, and throat team. The authors also discuss key techniques that allowed them to overcome the challenges of this complex case, such as creating a parallel landing zone to prevent cage subsidence. https://thejns.org/doi/10.3171/CASE25203.