Transient dorsal column dysfunction following extreme cervical deformity correction: Report of 3 cases

Abstract Background Chin-on-chest kyphotic cervical deformity can be debilitating. Surgical deformity correction serves to decompress neural elements and restore lordosis. This can be achieved through multiple osteotomies with instrumentation and fusion, sometimes requiring a staged approach. Such procedures carry a high risk of neurological injury. Here we present examples of transient neurological dysfunction not previously reported in the common literature. Case Description The authors present three patients who underwent extreme cervical deformity correction for chin-on-chest deformity. Deformity correction in all cases was obtained through multiple osteotomies with multi-level cervicothoracic posterior instrumentation and arthrodesis. On postoperative examination, all three patients developed transient ataxia, dysmetria, and decreased proprioception in all four extremities – exam findings consistent with dorsal column dysfunction. All symptoms resolved within two to three weeks post-operatively. Conclusion Incomplete spinal cord syndromes such as posterior cord syndrome can be caused by compression or stretching of the ascending dorsal spinal tracts. Considering the large degree of correction obtained, we hypothesize the resulting shortening of the dorsal columns as the pathomechanism. Providers should be aware and patients should be counseled pre-operatively that these symptoms may occur. If these symptoms are present postoperatively, appropriate diligence is warranted with the understanding that these deficits may be transient.