Osteotomy of the Cervical Spine

Corrections of a severe flexion deformity and slight hyperextension of the cervical spine was produced safely at the level between the seventh cervical vertebra and first thoracic vertebra in a woman, forty-four years old. The osteotomy was performed posteriorly under local anaesthesia; the ossified annulus fibrosis was ruptured anteriorly by manipulation under nitrous oxide and oxygen anaesthesia while the spinal canal was exposed and protected by the surgeon. Full correction of the deformity was attempted only under controlled conditions after the patient was fully awake and after the spine was securely immobilized in a full spinal brace equipped with a jury-mast and a turnbuckle to raise the chin. The turnbuckle was unthreaded slowly and the cervical spine was extended in stages while the patient was closely observed and frequently examined to test her sensory perceptions, reflexes, and muscle power.