A Sterile-freehand Reduction Technique for Corrective Osteotomy of Fixed Cervical Kyphosis

Sang-Hun Lee, MD; Ki-Tack Kim, MD; Kyung-Soo Suk, MD; Man-Ho Kim, MD; Dae-Hyun Park, MD; Kyu-Jin Kim, MD


Spine. 2012;37(26):2145-2150. 

In This Article


Preoperative diagnoses were AS in 5 cases and postinfectious kyphosis and idiopathic fixed kyphosis in 1 case each. The mean follow-up period was 16.5 (range, 12–21) months.

The type of osteotomy performed was PSO in 5 cases and anterior-release–posterior osteotomy in 2 cases. PSO was performed on C7 in 5 cases and on C6 in 1 case. The upper instrumented vertebra was C3 in 5 cases, and C1 and the occiput in 1 case each. The lower instrumented vertebra was T3 in 4 cases, and T1 and T2 in 1 case each. The mean number of instrumented segment was 6.7 (range, 5–8).

For cervical spine fixation, cervical pedicle screws were placed in 5 cases and both lateral mass screws and cervical pedicle screws were used in 2 cases. For thoracic spine fixation, pedicle screws were used in all cases (Table 1). A 3.5-mm titanium rod was used in all cases.

The mean operative time was 5.2 (range, 4.7–7.6) hours, and the mean intraoperative blood loss was 548 (range, 430–950) mL. The mean correction angle was 39.7° (range, 28°–63°) on the sagittal plane and 9.3° (range, 0°–16°) on the coronal plane. The mean correction of chin-brow vertical angle was 37.1° (18°–61°) (Figure 3). In 1 case (case 7) MEP decreased by approximately 60% on the left side before correction, but the wake-up test and final result showed no neurological complications. There were no clinical complications, including neurovascular complications. Rigid fixation technique using lateral mass screws or cervical pedicle screws placement, free ambulation was permitted as soon as possible with adjustable neck braces (Vista; Aspen medical products Inc., Irvine, CA) for 3 months after surgery. There was no correction loss or fixation failure during the follow-up periods. Follow-up 3D computed tomography showed solid union of the osteotomy in all cases.

Figure 3.

Preoperative (A and B) and postoperative (C and D) radiographs of a 38-year-old patient with ankylosing spondylitis (case 3). Correction angle was 40° in the sagittal plane and 16° in the coronal plane.