Multi-Level Uncinatectomies and Posterior Column Osteotomies to Correct a Cervical Kyphotic Deformity: Case Instruction With Intraoperative Picture and Video

BACKGROUND AND IMPORTANCE: Cervical deformity is a debilitating pathology that can result from trauma, infection, tumor, or previous surgery. The authors sought to provide a technical and visual description of an anterior-posterior fusion to correct a fixed cervical kyphotic deformity with multi-level anterior uncinatectomies and posterior column osteotomies (PCOs). CLINICAL PRESENTATION: A 71-year-old man with a history of diffuse idiopathic skeletal hyperostosis and a prior C5/6 fracture resulting in a fixed kyphotic deformity presented with severe mechanical neck pain and inability to maintain a horizontal gaze. Imaging revealed a kyphotic compression fracture at C6, with significant kyphosis from C5-T1, anterior/posterior ossification, and multiple level autofusion. The patient underwent a combined anterior-posterior procedure, starting with C4/5, C5/6, and C7/T1 anterior cervical discectomy and fusions with uncinatectomies, facilitating spinal realignment. The posterior approach included C2-T4 instrumented fusion and C2-T1 PCOs. The combined strategy achieved significant sagittal correction, restoring cervical lordosis and sagittal balance. At 1-year follow-up, the patient maintained improved alignment without neurologic deficits. CONCLUSION: A fixed cervical kyphotic deformity presents significant surgical challenges. We hereby provide a step-by-step description of the anterior-posterior approach with multi-level anterior uncinatectomies and PCOs to correct a fixed cervical kyphotic deformity in a patient with remote fractures and diffuse idiopathic skeletal hyperostosis. We described surgical nuances and key steps to achieve a safe and adequate deformity correction.