Pedicle reduction osteotomy in the upper cervical spine: Technique, case report and review of the literature

Objective To present a case report of the correction of a degenerative cervical 45-degree kyphosis centered at C4 with a single stage PSO. Summary of Background Data Correction of a fixed cervical kyphosis is a surgical challenge that is frequently managed with a combination of anterior and posterior surgical procedures. An alternative the three stage operation is a single stage pedicle subtraction osteotomy (PSO). A PSO releases the posterior, middle and anterior columns of the spine by resecting the facet joints, pedicles, and a portion of the vertebral body at the apex of a kyphosis through a posterior approach. Methods This was a case report of a patient who had degenerative cervical 45 degree kyphosis and was corrected with a single stage pedicle subtraction osteotomy. We did a literature review to provide information on current techniques to treat these patients. Results With careful resection of the lateral mass and decompression of the vertebral artery by removal of the posterior margin of the foramen transversarium the upper cervical pedicles can be accessed and a PSO can be performed. The vertebral arteries were not obstructed or kinked with posterior reduction of the PSO in this case. Conclusions A closing wedge PSO is a useful tool for correcting fixed kyphotic deformities in the upper cervical spine. Further studies are necessary to evaluate the long-term outcomes in these patients.