Cervical Spine Deformity

Indications, Considerations, and Surgical Outcomes

Samuel K. Cho, MD; Scott Safir, MD; Joseph M. Lombardi, MD; Jun S. Kim, MD


J Am Acad Orthop Surg. 2019;27(12):e555-e567. 

In This Article


Care should be taken to identify the vertebral arteries on preoperative MRI and to protect them during surgery. For maximal mobilization and induction of lordosis, we recommend wide exposure to the lateral margin of the uncinates bilaterally (Figure 8). If a previous fusion had been present, a high-speed burr can be used to take down the fusion at the original disk space to the level of the posterior longitudinal ligament. Concomitant coronal deformity can be corrected with asymmetric resection of the fusion mass. Prophylactic foraminotomies are performed to prevent root injury with spine extension. Diverging distraction pins can also be used so that distraction recreates lordosis. Two pins can be used on each VB to distribute forces if bone quality is poor. The head can be propped up with sheets initially and gently pushed down on the forehead with removal of the sheets one at the time on completion of the osteotomy to induce lordosis.[32]

Figure 8.

Chin-on-chest kyphoscoliosis. This patient underwent C4-C7 anterior osteotomies (with standalone cages and one screw fixation) combined with C2-T3 posterior spinal fusion with multilevel Smith-Petersen osteotomies. C2 has two pars screws and one intralaminar screw as proximal anchors.