Acute progressive adolescent idiopathic cervical kyphosis: case report

Abstract

Acute progressive adolescent idiopathic cervical kyphosis (AICK) is rare, and its treatment strategy is controversial. The authors present a case of AICK successfully treated with preoperative halo-gravity traction, followed by combined anterior-posterior surgery. A 15-year-old girl with no relevant past or family history presented with axial neck pain without any cause. A few months after the development of cervical myelopathy, cervical kyphosis progressed to 71° despite conservative treatment. CT scanning demonstrated osteophyte formation at the anterior aspect of the vertebral body. MRI showed a forward migration of the spinal cord with a ratio (C/M ratio) between the anteroposterior diameter of the medulla-pons junction and the spinal cord at the apex of the kyphosis of 0.27. After 2 weeks of preoperative halo-gravity traction, anterior release and posterior fusion was performed. After surgery, cervical kyphosis was corrected to 0°, and cervical myelopathy improved. One year after surgery, the patient was neurologically intact, and bony union and improved cervical alignment were observed. Preoperative halo-gravity traction followed by combined anterior-posterior surgery led to safe and effective correction. Osteophyte formation at the anterior aspect of the vertebral body and the C/M ratio were useful in predicting the progression of AICK.