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. 2018;26(6):415-417.
doi: 10.1590/1413-785220182606169271.

SURGICAL CORRECTION OF SEVERE AND FIXED CHIN-ON-CHEST DEFORMITY

Raphael Martus Marcon  1 , Allan Hiroshi de Araujo Ono  1 , Flávio Gerardo Benites Zelada  1 , Alexandre Fogaça Cristante  1 , Tarcísio Eloy Pessoa Barros  1
Affiliations

SURGICAL CORRECTION OF SEVERE AND FIXED CHIN-ON-CHEST DEFORMITY

Raphael Martus Marcon et al. Acta Ortop Bras. 2018.

Abstract
in English, Portuguese

Objective: To describe a successful surgical treatment for the challenging severe and fixed chin-on-chest deformity due to isolated neck extensor myopathy (INEM).

Background data: INEM is an idiopathic cause of dropped head syndrome (DHS) that results in severe cervicothoracic kyphosis, defined as chin-on-chest deformity. The existing literature on surgical management is limited, with outcomes ranging from poor to excellent. INEM may present to the spinal surgeon for consideration of surgical management.

Methods: The authors present a technique that uses a staged posterior and anterior approach combined with osteotomies and corpectomy to correct the severe and fixed deformity. A state of the art anterior and posterior instrumentation system was used.

Results: At the three-months follow-up, there was good deformity correction and the patient's satisfaction was high, with no neurological deterioration occurring.

Conclusions: The technique illustrated in this study represents a successful option to treat this debilitating deformity. More evidence is needed to set up a definitive algorithm for the management of this condition. Level of evidence IV, Case Report.

Objetivo: Descrever o tratamento cirúrgico de deformidade desafiadora, grave, de queixo-no-peito devida a miopatia isolada do extensor do pescoço.

Contexto: A miopatia isolada do extensor do pescoço é uma causa, idiopática, da síndrome da cabeça caída. Resulta em grave cifose cérvico-torácica, chamada de “deformidade queixo-no-peito”. A literatura sobre o tratamento cirúrgico da deformidade é limitada, com resultados de pobres a excelentes. A miopatia isolada do extensor do pescoço pode ser considerada para tratamento cirúrgico.

Métodos: Os autores apresentam a técnica, que usa vias anterior e posterior em estágios, combinadas com osteotomías e corpectomia para corrigir a deformidade, grave e fixa. A melhor instrumentação e sistemas para abordagem anterior e posterior foram utilizadas.

Resultados: Após três meses de follow-up, houve boa correção da deformidade e a satisfação da paciente foi alta, sem deterioração do status neurológico.

Conclusões: A técnica se mostrou boa opção para tratamento de sucesso desta deformidade. Mais evidências são necessárias para estabelecer um algoritmo definitivo para a condução dessa deformidade. Nível de evidência IV, Relato de Caso.

Keywords: Cervical vertebrae; Decompression, surgical; Osteotomy; Spinal diseases; Surgical procedures operative.

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Conflict of interest statement

All authors declare no potential conflict of interest related to this article.

Figures

Figure 1
Figure 1. Clinical photos of the patient showing the fixed chin-on-chest deformity with the head rotated to the right, before surgery.
Figure 2
Figure 2. Surgical procedure.
Figure 3
Figure 3. Radiographic images after surgery.
Figure 4
Figure 4. Clinical photos showing the patient after surgery.
See this image and copyright information in PMC

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