What is the treatment for cervical spine kyphosis?

Treatment for Cervical Spine Kyphosis

The optimal treatment for cervical spine kyphosis requires surgical correction with deformity-specific techniques based on the etiology, severity, and rigidity of the kyphosis to improve neurological function and quality of life.

Evaluation and Classification

Before determining treatment, proper evaluation is essential:

• Radiographic assessment:

  • Cervical lordosis measurement
  • C2-7 sagittal vertical axis
  • Chin-brow to vertical angle
  • T1 slope 1
  • Upright lateral 36-inch film for accurate measurement

• Clinical presentation assessment:

  • Neck pain
  • Neurological symptoms (myelopathy, radiculopathy)
  • Functional impairment (horizontal gaze problems, swallowing difficulties)
  • Breathing issues 1

Treatment Algorithm

Conservative Management

Conservative management has limited role in established cervical kyphosis but may include:

• Physical therapy for mild cases
• Bracing for temporary support
• Pain management

Surgical Indications

Surgery is indicated for:

• Progressive neurological deterioration
• Severe pain unresponsive to conservative measures
• Functional disability affecting quality of life
• Progressive deformity

Surgical Approach Selection

1. Anterior-only approach:

   • Appropriate for fixed deformities without ankylosing spondylitis
   • Allows for anterior decompression and kyphosis correction
   • Options include anterior discectomy and fusion or anterior osteotomy 2

2. Combined anterior-posterior approach:

   • Recommended for fixed deformities or deformities at the cervicothoracic junction
   • Principle: lengthen anterior column and shorten posterior column
   • Provides more stable correction for severe kyphosis 2

3. Posterior-only approach:

   • Can be used when correction is achievable with traction without anterior compression
   • Options include Smith-Peterson osteotomy or pedicle subtraction osteotomy 1

4. Three-stage approach:

   • Reserved for the most complex cases
   • May be necessary for severe fixed deformities 2

Special Considerations

• Ankylosing spondylitis-related kyphosis:

  • Often requires osteotomy for correction
  • Deformity typically develops at cervicothoracic junction 2
  • The American College of Rheumatology conditionally recommends against elective spinal osteotomy in most cases due to high risks (4% mortality, 5% permanent neurological sequelae) 3
  • Consider only in severe cases with horizontal gaze impairment causing major physical and psychological impairment

• Post-traumatic kyphosis:

  • May require preoperative skeletal traction followed by circumferential instrumentation and fusion 4
  • Early immobilization of suspected spinal cord injury is recommended to limit neurological deficit 3

Potential Complications

• Neurological deterioration (including temporary anterior spinal artery syndrome)
• Wound infection
• Hardware failure
• Pseudarthrosis
• Adjacent segment disease 4

Outcomes

Surgical correction of cervical kyphosis can result in:

• Improved quality of life
• Enhanced neurological status
• Better cervical alignment
• Pain reduction

In one study, 89.7% of patients showed improvement or no changes after surgery, with average neck disability index improving from 25.5 preoperatively to 14.3 at one year postoperatively 2.

Cautions

• Spinal manipulation with high-velocity thrusts is strongly contraindicated in patients with spinal fusion or advanced spinal osteoporosis 3
• Surgery should be performed at specialized centers by surgeons with extensive experience in deformity correction techniques

The choice of surgical approach should be based on careful preoperative evaluation of the deformity characteristics and patient-specific factors to maximize neurological recovery and functional improvement.