Case 1, presented by Craig D. Steiner, MD, Han Jo Kim, MD, and Todd J. Albert, MD describes a 71-year-old male who presented for evaluation of progressive spinal deformity as a result of a rock climbing accident. The injury had previously been managed conservatively, and after recovery he had been able to return to work. Over the year prior to presentation, he noted progressive chin on chest deformity and an inability to maintain horizontal gaze for any length of time. His ambulatory tolerance became limited to less than a block secondary to neck pain, periscapular pain, fatigue, and paresthesias in the distal lower extremities during ambulation. After evaluation, the patient, having failed conservative treatment, elected surgical intervention. The surgical plan called for a posterioranterior-posterior cervical osteotomy, decompression and cervicothoracic fusion undertaken in a single surgical session. Postoperatively, the patient was able to walk upright without limitation, and maintain horizontal gaze indefinitely without discomfort (Figure 3a).
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