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Cervicothoracic Kyphosis (Dropped Head Deformity) Surgery Complication

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Book cover Spinal Deformity

Abstract

Cervicothoracic kyphosis is a complex group of disorders frequently associated with chin-on-chest deformities which can significantly affect the patient’s ability to maintain horizontal gaze, produce pain, and cause severe functional disability. Accompanying these disorders frequently are neuromuscular conditions like myopathies and chronic inflammatory arthropathies like ankylosing spondylitis and rheumatoid arthritis, creating further challenges in managing these deformities. Unlike the thoracolumbar deformities, substantial efforts have not been made to characterize clinical presentations, apply standardized classification systems, define optimal treatment approaches, describe operative complication rates, and present structured clinical outcomes for adult cervical deformities. Health professionals providing nonoperative and surgical care for these patients are left to make important treatment decisions based on a combination of personal experience, anecdotal experience of colleagues and experts, and relatively small, often single-surgeon or single-center, retrospective case reports or case series in the literature. This has posed a great challenge in counseling such patients regarding the prognosis and explaining to them the possible complications following surgery for cervical and cervicothoracic deformities. Based on the approach, surgical invasiveness, performance of osteotomies, and surgeon expertise, early postoperative complications have ranged from 20 to 80% including medical complications, dysphagia, postoperative C5 nerve palsy, surgical site infections, and early instrumentation failure. Mid- to long-term complications include pseudoarthrosis, hardware failure, and adjacent segment and junctional pathologies. We present a case of ankylosing spondylitis with cervicothoracic kyphosis operated for deformity correction developing subsequent distal junctional kyphosis.

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Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, NYU Langone Medical Center’s Hospital for Joint Diseases, 306 E 15th Street, Apartment 4R, New York, NY, 10003, USA

    Subaraman Ramchandran

  2. Department of Orthopedic Surgery, NYU Langone Medical Center, 301 East 17th Street, Suite 400, New York, NY, 10003, USA

    Themistocles S. Protopsaltis

  3. Department of Neurological Surgery, University of California, 505 Parnassus Avenue, RM M779, Box 0112, San Francisco, CA, 94143, USA

    Christopher P. Ames

Authors
  1. Subaraman Ramchandran
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  2. Themistocles S. Protopsaltis
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  3. Christopher P. Ames
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Corresponding author

Correspondence to Christopher P. Ames .

Editor information

Editors and Affiliations

  1. Joan O’Reilly Endowed Professor in Spinal Surgery, Vice Chairman, Department of Neurosurgery, University of California, San Francisco, California, USA

    Praveen V. Mummaneni

  2. Professor, Director of Spinal Surgery, Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA

    Paul Park

  3. University of Louisville, Norton Leatherman Spine Center, Louisville, Kentucky, USA

    Charles H. Crawford III

  4. Chief, Division of Spine Surgery, Associate Professor of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA

    Adam S. Kanter

  5. Department of Orthopedic Surgery, University of Louisville, Norton Leatherman Spine Center, Louisville, Kentucky, USA

    Steven D. Glassman

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Ramchandran, S., Protopsaltis, T.S., Ames, C.P. (2018). Cervicothoracic Kyphosis (Dropped Head Deformity) Surgery Complication. In: Mummaneni, P., Park, P., Crawford III, C., Kanter, A., Glassman, S. (eds) Spinal Deformity . Springer, Cham. https://doi.org/10.1007/978-3-319-60083-3_9

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  • DOI: https://doi.org/10.1007/978-3-319-60083-3_9

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-60082-6

  • Online ISBN: 978-3-319-60083-3

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