The 'candy cane' technique for construct augmentation and correction of severe angular chin-on-chest kyphoscoliosis

PurposeTo manage severe angular chin-on-chest deformity.MethodsA single midline incision and periosteal dissection were utilized to expose from C2 to T6. Bilateral C2 pars screws, C3 to C7 lateral mass screws, and T1 to T6 pedicle screws were placed. Following the placement of screws, multiple two column posterior osteotomies and interlaminar decompressions from C6 to T3 were performed to amplify both the sagittal and coronal corrections. Titanium rods were utilized in light of the patient's known osteopenia and nickel allergy. As such, the construct was augmented via the use of a third accessory rod. This third titanium rod was placed into a supplementary translaminar screw with three connectors to the right-sided main rod. Once the lordotic configuration of the contralateral main rod was secured, an additional corrective maneuver of gentle distraction across this third rod was employed to assist with coronal correction.ResultsIn this patient with osteopenia, a known nickel allergy, and significant cervical imbalance, the Candy Cane construct allowed for a durable correction of the severe sagittal and coronal plane deformity. The chin-brow angle was corrected by 44 degrees. The coronal Cobb angle improved by 10 degrees. On long-term follow-up, the patient reported continued satisfaction with the operation and was able to perform his activities of daily living.ConclusionA one-stage, posterior approach along with construct augmentation, with a third rod hooked into a supplementary C2 translaminar screw, can be employed for the correction of chin-on-chest kyphoscoliosis.

Automated summary

This study successfully managed severe angular chin-on-chest deformity through a single midline incision and periosteal dissection. The sagittal and coronal corrections were achieved by placing multiple screws, performing posterior osteotomies and interlaminar decompressions, and using a third titanium rod for construct augmentation. The patient showed durable correction and continued satisfaction with the operation on long-term follow-up.