Recurrent dysphagia after lower posterior cervical fusion

A case of delayed dyspnea after corrective posterior fusion of the middle and lower cervical spine for dropped head syndrome

Dyspnea has been reported to occur following posterior occipitocervical fusion. However, there are no documented cases of dyspnea following posterior fixation of the middle and lower cervical spine without posterior occipitocervical fusion. An 80-year-old woman underwent corrective fusion from T4 to the ilium for kyphoscoliosis. Sixteen months later, the patient developed cervical kyphosis (dropped head syndrome) with proximal junctional kyphosis, leading to a pedicle subtraction osteotomy at T4 and an extended fixation to C2. On the sixth postoperative day, the patient experienced respiratory arrest, prompting a reoperation to reduce cervical lordosis, ultimately resolving the respiratory dysfunction. Excessive correction of cervical kyphosis should be avoided to prevent the occurrence of postoperative dyspnea, even in cases where posterior occipitocervical fusion has not been performed.