Surgical treatment of cervical kyphosis

Abstract

Cervical kyphosis is an uncommon but potentially debilitating and challenging condition. We reviewed the etiology, presentation, clinical and radiological evaluation, and treatment of cervical kyphosis. Based on the current controversy as to the ideal mode of surgical management, we paid particular attention to the available surgical strategies. There are three approaches for cervical kyphosis: the anterior, posterior or combined procedures. The principal indication for the posterior strategy is a flexible kyphosis or kyphosis caused by ankylosing spondylitis. The main point of debate is between the choice of the anterior or the combined strategy. The two strategies were compared with regard to clinical outcome, correction of deformity, rate of fusion, complications, revision surgery, and mortality. The combined strategy appears to result in a greater degree of correction than the anterior-alone strategy, and it is more likely to improve the cervical alignment to achieve a lordosis. However, the procedure carries a higher rate of postoperative neurological deterioration, complications, revision surgery, and mortality. Although the anterior-alone strategy achieves a smaller reduction of cervical kyphosis, it has a lower rate of postoperative neurological deterioration, complications, revision surgery, and mortality. We recommend that the surgical treatment of cervical kyphosis should be planned on an individual basis. A multicenter, prospective, randomized controlled study would be necessary to determine the ideal mode of treatment for complex cervical kyphosis.

Fig. 1

A 17-year-old female had a idiopathic cervical kyphosis as shown by the preoperative lateral radiography (a). The spinal cord was draped over the apex of the kyphotic deformity (b). She underwent anterior discectomy and fusion combined with posterior fixation using lateral mass screws. She achieved a neutral alignment postoperatively (c) and solid fusion 4 months postoperatively (d)

Fig. 2

The initial preoperative MRI of a 15-year-old female showed an intradural extramedullary tumor and preexisting deformity of the cervical spine (a). She developed a severe cervical kyphosis (78°) (b, c, d) (later images taken when the patient was 23 years old) after she underwent cervical laminectomies for the tumor. She also had a quadriplegia over a period of 8 years. She underwent a 720º (anterior–posterior–anterior–posterior) fusion with instrumentation under a single anesthetic. She was able to walk unassisted 1 month after surgery. The angle of kyphosis was 46° immediately after surgery (e), and there was no loss of correction during the 3-year follow-up period (f). A solid fusion was achieved (f) and the spinal cord was significantly decompressed (d, g)

Fig. 3

A comparison between the anterior and combined strategies with regard to clinical and radiological outcomes, as well as complications