Treatment strategies and outcomes in the first reported case of severe "Reverse-Folding" spinal deformity: A 2-year follow-up case report.

Abstract

Severe spinal deformities represent rare and complex conditions requiring highly individualized treatment strategies. Among these, the "reverse-folding human" deformity has never before been reported in the medical literature. This study presents the first documented case of this condition, managed successfully through a multidisciplinary team approach and staged posterior spinal instrumentation and fusion. It also establishes the first framework for risk stratification and perioperative management of such extreme deformities. Case report. A 36-year-old woman presented with progressive cervical hyperextension over 26 years and thoracolumbar deformity over 17 years. Clinical and radiological evaluation revealed severe cervical hyperextension, spinal lordosis (Cobb angle: 140.1°), scoliosis (Cobb angle: 87.6°), and severe restrictive pulmonary impairment. The patient underwent a two-stage posterior spinal fusion (C2-S1). Postoperative outcomes included substantial improvement in alignment and gait, with no neurological or mechanical complications over two years of follow-up. This case demonstrates the feasibility and efficacy of a staged full-spine surgical approach in managing unprecedented spinal deformities. The successful outcome highlights key elements for similar cases: patient-specific surgical planning, staged correction to reduce risks, and coordinated MDT involvement. This report provides a critical clinical reference and treatment framework for managing rare and severe spinal deformities, including the newly defined "reverse-folding human" condition.