Surgical treatment of neck hyperextension in myopathies

Neck hyperextension occurs in relation to several myopathies. It is a progressive increase of lordosis associated with a limitation in flexion of the cervical spine, forcing the patient to assume awkward compensatory postures to maintain balance and level vision. We evaluated operative complications, degree of correction, achievement of a solid arthrodesis, maintenance of the correction, and clinical assessment of seven patients. All had surgery in which the interspinous processes between C2-C7 were opened in a posterior approach and bone graft wedges driven into them to maintain the correction. The mean age of patients at the time of surgical intervention was 16.5 years (range, 10-28 years). The average followup was 10.4 years (range, 2.4-16.5 years). No major surgical complications occurred. After surgery, the average angle between C2-C7 in neutral position had decreased from 50.7° (range, 40°-70°) to 21.4° (range, 2°-50°). The range of motion in the C1-C2 joint remained unaffected, whereas it decreased in C2-C7 from 33.5° (range, 15°-64°) to 1.8° (range, 0°-8°). A solid arthrodesis was achieved in all patients The followup showed significant clinical improvement of posture in all patients. The operating technique used proved to be safe and effective.