1458. A Novel Method For Controlled Reduction of a Cervicothoracic Kyphosis Related to Spinal Metastasis with Crossing Rods and Tension Cable: Case Report and Literature Review

Authors: Sean Michael Barber, MD; Thomas Kosztowski, MD; Jared Fridley, MD; Jonathan Nakhla, MD; Sanjay Konakondla, MD; Ziya Gokaslan, MD (Providence, RI)

Introduction: The intraoperative reduction of profound cervicothoracic kyphotic deformities through the use of anterior column osteotomies is associated with a considerable risk of spinal cord injury due to iatrogenic subluxation. Various methods for safe reduction of such a deformity have previously been described, including awake intraoperative reduction, among others. Many of these previously described methods are, however, impractical, and still associated with a relatively high risk of neurological injury. Methods: The authors describe a novel method used for the safe intraoperative reduction of a profound cervicothoracic kyphotic deformity in a patient with spinal metastatic disease. Technical details of the reduction method are described, and the literature regarding the subject is reviewed. Results: A 61-year-old male presented with scapular pain and progressive cervicothoracic kyphosis and was found on imaging to have a right apical lung mass (non-small-cell carcinoma) with extension into the C7 - T3 vertebral bodies along with focal T2/3 kyphosis and severe central stenosis without spinal cord compression. He underwent a single-stage posterior approach to the cervicothoracic spine, C2 - T7 posterior instrumentation, and bilateral T1 - T2 corpectomies. After the osteotomies, the cervicothoracic deformity was reduced in a controlled manner through the use of crossing thoracic and cervical rods connected to one another by tension cables. The tension on the wires was gradually increased, slowly bring the spine back into normal alignment in a safe, controlled manner. After reduction, the anterior column was reconstructed with a chest tube/polymethylmethacrylate construct. The patient remained neurologically stable post-operatively, and 6-month post-operative imaging demonstrated stable alignment. Conclusion: We describe a novel method for the controlled, intraoperative reduction of a profound cervicothoracic deformity using crossing cervicothoracic rods and tension cable. This method allows for the safe reduction of profound deformities under general anesthesia without the risk of iatrogenic subluxation and neurological injury.