Case 2, presented by Stelios Koutsoumbelis, MD, and Federico P. Girardi, MD describes a 41-year-old female who presented with a 2.5 year history of neck pain, discomfort in her shoulders and severe neck dystonia with fixed kyphosis. The symptoms began after an a traumatic neck muscle strain. The patient has been unable to correct he neck position since then. Radiographs revealed rigid cervical kyphosis from C2 to C7 with significant angulation involving the occipitocervical area (Figure 1). Full length standing radiographs demonstrated the chin on chest deformity and CT imaging showed the fixed C1-C2 deformity (Figure 2). MR imaging and myelogram were performed and revealed no abnormalities or significant cord signal changes. The patient underwent an anterior cervical decompression and fusion (ACDF) from C3 to T2, followed by a posterior spinal fusion from the occiput to T2 with use of iliac crest bone autograft. This surgery was done in one sitting. During the procedure, the patient also underwent a tenotomy of the right sternocleidomastoid. Postoperatively she was placed in a rigid cervical orthosis and transitioned to a soft collar after two weeks. At 3 months the patient reported that her overall preoperative symptoms had improved by 60% and at 6 months her neck pain had improved by 90% and overall alignment by 95%. Postoperative x-rays show successful fusion with restored neck alignment (Figure 3).
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