Progressive Acquired Cervical Deformity With Myelopathy Managed by Occipitocervicothoracic Fusion: A Case Report

Progressive cervical myelopathy associated with acquired cervical deformity is uncommon and presents substantial diagnostic and surgical challenges, particularly when the deformity is rigid and complicated by anomalous vascular anatomy. Severe focal stenosis at the apex of cervical kyphosis and segmental autofusion may increase the risk of neurologic injury during decompression and hinder deformity correction. We report the case of a 55-year-old woman with progressive cervical myelopathy in the setting of an acquired cervical kyphoscoliosis. Although no definitive traumatic event was identified, remote trauma was suspected to have contributed to the development of the cervical deformity and subsequent stenosis. Imaging demonstrated severe focal stenosis from C4-6 at the kyphotic segment, spondylolisthesis at C3-4 and C4-5, autofusion through the C3-4 disc space and right facet joint, and marked deformity of the left C3 and C4 lateral masses. Additionally, atypical vertebral artery anatomy from C2 to C4 on the left increased the risk associated with posterior cervical instrumentation. The deformity was rigid and failed to correct with traction. Given progressive neurologic decline and severe cord compression, the patient underwent posterior decompression and stabilization with C3-7 laminectomy and occiput-T2 fusion. Instrumentation included an occipital plate, C2 pars screws, subaxial lateral mass screws where feasible, and T1-T2 pedicle screws (DePuy-Synthes Symphony, Johnson & Johnson MedTech, Warsaw, USA). CT-assisted navigation (BrainLab, Munich, Germany) and multimodal neuromonitoring (motor evoked potentials, somatosensory evoked potentials, and electromyography) were used to mitigate neurologic and vascular risk. Controlled derotation was performed by adjusting the Mayfield head holder, with the degree of correction limited by autofusion at C3-4. Fusion was augmented with local autograft and allograft. This case highlights the complexity of operative planning and execution for progressive acquired cervical myelopathy in the setting of a very uncommon deformity with autofusion and aberrant vertebral artery anatomy. Navigation, neuromonitoring, and construct selection are useful risk-mitigation strategies when decompression and stabilization are required in high-risk anatomy.