Acute swan-neck deformity and spinal cord compression after cervical laminectomy.

CASE REPORT A 42-year-old female patient presented with a five-month history of progressive left-sided weakness, unsteady gait, and bilateral hand clumsiness. Patient’s symptoms had been rapidly progressing over the past several weeks resulting in a loss of her ability to ambulate independently. There was no urinary or fecal incontinence. Neurological examination revealed left spastic hemiparesis with 3-4-/5 motor strength in the left upper and lower extremities, generalized hyperreflexia with clonus, and bilateral Babinski sign. The clinical diagnosis of cervical myelopathy was made and magnetic resonance imaging of the cervical spine was performed revealing severe cervical spondylosis with loss of lordosis, marked spinal canal narrowing, and significant spinal cord compression from C2 to C6 (Figure 1). Posterior cervical decompression through multilevel C3 to C6 laminectomies was performed. During the procedure, the laminae of C2 were partially exposed by subperiosteal dissection of the paraspinal muscles. Given the preoperative loss of lordosis, noninstrumented fusion of the facet joints from C2 to C7 using onlay morselized autologous bone graft was performed. Therefore, although facets were preserved, their capsules were completely resected. Blood pressure was maintained at adequate levels during the whole procedure and there were no intraoperative complications. The patient tolerated the surgery very well and was extubated and transferred to the floor. On the first post-operative day, the patient exhibited rapid neurological deterioration and quadriplegia with a bilateral complete C7 motor and sensory level. Cervical spine MRI was urgently performed and revealed severe swan-neck deformity of the cervical spine with a 30° kyphotic angle (Figure 2). The patient was started on high-dose intravenous dexamethasone and taken to the operating room where closed manual reduction was attempted with the Mayfield head holder under fluoroscopy and general anesthesia. However, given our inability to obtain good lordotic alignment, we elected to perform an anterior surgical release followed by a 360° fusion. Anterior C4-C5 and C5-C6 discectomy and fusion using lyophilized bone allograft and a cervical plate was initially Acute Swan-Neck Deformity and Spinal Cord Compression after Cervical Laminectomy