Specialized Spinal Care Corrects Complex Neck Deformity

As someone who has lived for decades with rheumatoid arthritis, Lynn Gaus, 68, of De Pere, is accustomed to physical discomfort.

But in recent years, she developed a literal pain in the neck that dramatically limited her ability to move her head and neck. She also noticed a leftward tilt to her head that she was unable to straighten. When she mentioned this to her local rheumatologist in the summer of 2023, he ordered an X-ray and MRI of her neck and referred her to a spine surgeon in Appleton. The specialist was startled by what he saw. 

“He took one look at my X-rays and said I needed highly specialized care,” Lynn said. “He sent me to Froedtert Hospital.”

Lynn, along with her husband, John, came to Froedtert Hospital, the academic medical center of the Froedtert & the Medical College of Wisconsin health network, to consult with Saman Shabani, MD, spine surgeon and MCW faculty member. He has specialized training in both spinal deformities and spinal oncology.

Imaging Reveals Swan Neck Deformity in Spine

Dr. Shabani ordered additional imaging, which revealed a significant S-curve at the top of her spine, sometimes called “swan neck deformity,” as well as cervical stenosis, a painful narrowing of the spine that was pinching the spinal cord and nerve roots. He also diagnosed her with basilar invagination, a rare condition in which the vertebrae at the top of the spine shift position, causing the skull to sink toward the top of the spine.

“In basilar invagination, the vertebrae that hold the head on the spine soften to the point that they can no longer hold the head,” Dr. Shabani said. “It’s like having a house with no foundation.”

Basilar invagination can be caused by spine injuries, bone diseases or defects present at birth. In Lynn’s case, Dr. Shabani said rheumatoid arthritis contributed to the degeneration. Over time, basilar invagination can compress the brain stem and spinal cord, leading to problems including swallowing and breathing difficulties, as well as numbness and weakness in the arms or legs.

Spinal Surgery and Physical Therapy to Stabilize the Neck

People with mild cases of basilar invagination may be treated with physical therapy and anti-inflammatory drugs. Because Lynn’s disease was significant, Dr. Shabani recommended surgery to stop its progression. In August 2023, she had an extensive six-hour surgery at Froedtert Hospital.

“We used several different methods to bring her head and neck back to the proper position and shape,” Dr. Shabani said. These strategies included using a rod to fuse the vertebrae of her cervical spine, making her neck more stable, and removing bone and tissue to create more space in her cervical spine for her spinal cord and nerves. After surgery, Lynn noticed an immediate improvement.

“My neck was much better and my head tilt was gone,” she said. Lynn remained in the hospital for eight days after surgery and began intensive physical therapy. One goal of the therapy was to address C5 palsy, a common side effect she developed following surgery. C5 palsy caused weakness in her right arm, but therapy sessions helped her regain its strength. Once discharged, she returned home and wore a collar for several weeks to stabilize her neck. She continued to receive physical therapy at a clinic near her home.

A Collaborative Approach and Progressive Technology

Dr. Shabani performs a range of spine procedures, from minimally invasive discectomies, which relieve pressure on herniated discs, to complex surgeries involving spine tumors and deformities such as scoliosis. He sees complicated cases regularly, and patients benefit from this experience, as well as the collaborative approach within the Froedtert & MCW SpineCare Program.

“In addition to state-of-the-art technology to help us plan these surgeries, an extensive multidisciplinary team collaborates with me during and after spine surgeries,” Dr. Shabani said. “The team includes high-risk case anesthesiologists, intensive care unit doctors and nurses, physical medicine and rehabilitation doctors and physical therapists. Team members also work together to help patients who need extra help addressing pain immediately after surgery.”

Positive Outcome from Spinal Surgery

Lynn returned to Froedtert Hospital many times over the next year for regular check-ups with Dr. Shabani. He was pleased with her progress.

“She did phenomenally after surgery,” he said.

Lynn gives a lot of the credit to her husband, John, who cared for her during her recovery. She is also glad she was able to access Dr. Shabani’s expertise and was impressed by the kindness and efficiency of the nurses and staff she encountered at Froedtert Hospital.

“Dr. Shabani’s entire team has been fabulous,” she said.

Spine experts from many disciplines work together at Froedtert & MCW SpineCare Clinics to treat even the most complex spine issues. Visit froedtert.com/spine-care.

These specialists and clinics are part of the Wisconsin Institute of NeuroScience (WINS). Read more about WINS.