Anterior Fibular Graft and Posterior Fusion for Proximal Cervical Kyphosis Following Resection of Posterior Fossa Ependymoma

Case: A 4-year-old boy with a history of posterior fossa ependymoma resection and radiation treatment developed postlaminectomy kyphosis at the occipito-cervical junction. Cervical radiographs showed 46° kyphosis between C2 and C4. A 3-stage surgical approach was done: halo-gravity traction, anterior C2 to C4 fusion with a fibular allograft, and posterior occiput-C4 instrumented fusion. Halo traction reduced kyphosis by over 50%. At 1-year follow-up, the patient showed stable fixation and successful fusion with modest limitation in cervical motion. Conclusion: The approach effectively corrected the deformity and successfully achieved fusion despite previous radiation treatment and bone deficiency in a very young, skeletally immature patient.