Myelopathy and spinal deformity: relevance of spinal alignment in planning surgical intervention for degenerative cervical myelopathy

Abstract

Surgical management of degenerative cervical myelopathy requires careful pathoanatomic consideration to select between various surgical options from both anterior and posterior approach. Hitherto, unexplored is the relevance of cervical deformity to the pathophysiology of such neurological disability, and whether correction of that deformity should be a surgical objective when planning for reconstruction after spinal cord decompression. Such correction could address both the static cord compression and the dynamic repetitive cord injury, while also restoring more normal biomechanics to the cervical spine. The articles in this focus issue's section on cervical spinal deformity reveal that cervical sagittal alignment is geometrically related to thoracolumbar spinal pelvic alignment and to T1 slope, and that it is further clinically correlated to regional disability and general health scores and to myelopathy severity. These conclusions are based on narrative reviews and a selection of primary research data, reflecting the nascency of this field. They further recommend for preoperative assessment of spinal alignment when significant deformity is suspected, and that correction of cervical kyphosis should be an objective when surgery is planned.