Posterior thoracic discectomy and interbody fusion for the correction of severe hyperkyphotic deformity: technical note and case report.

BACKGROUND: Rheumatoid arthritis (RA)-related severe manifestations in the cervical spine have become less prevalent since the introduction of disease modifying anti-rheumatic medications. Nonetheless, the consequences of subaxial subluxations and potential for cord compression leading to myelopathy are significant and often demand complex surgical decompression and fixation strategies. We present a novel case of severe T1/2 hyperkyphotic deformity complicated by osteoporosis requiring significant intraoperative reduction and multi-level cervicothoracic fusion.

CASE DESCRIPTION: A 75-year-old female with RA and multi-level subaxial cervical spine subluxation with resultant cord compression and myelopathy presented with T1/2 severe hyperkyphosis due to bony chance pedicular fractures 6 months after her index operation. This complication is especially rare at this non-junctional level which is challenging to fixate. The angulation precluded an anterior approach due to the fixed proximity of the chin to the sternum. A novel posterior modified trans-pedicular and trans-facet approach was utilized to access the disc space, release the anterior ligamentous structures and place an anterior cervical interbody cage without any nerve root sacrifice. There was excellent correction of the deformity, and clinically her mobility improved as a result of her spinal cord decompression.

CONCLUSIONS: This is the first report of a posterior thoracic interbody discectomy and fusion performed without nerve root sacrifice and we posit this as a viable surgical technique that circumvents the need for an anterior more invasive trans-thoracic approach. We discuss the novel technique of successful placement of an interbody device in order to facilitate correction of a hyperkyphotic thoracic deformity in a patient with severe osteoporosis and RA.