What is the treatment for abnormal cervical lordosis?

Treatment for Abnormal Cervical Lordosis

The most effective treatment for abnormal cervical lordosis includes a combination of cervical extension traction, spinal manipulation, and specific exercises to restore normal cervical curvature and reduce associated symptoms. 1

Understanding Abnormal Cervical Lordosis

Abnormal cervical lordosis refers to alterations in the normal curvature of the cervical spine, which can manifest as:

• Loss of normal lordosis (straightening)
• Reversal of lordosis (kyphosis)
• Hyperlordosis (excessive curvature)

These abnormalities can lead to:

• Neck pain
• Headaches
• Radiculopathy
• Decreased range of motion
• Potential for accelerated degenerative changes

Conservative Treatment Options

First-Line Approaches

1. Chiropractic Biophysics (CBP) Technique

   • Extension-compression cervical traction
   • Shown to decrease chronic neck pain intensity and improve cervical lordosis in approximately 38 visits over 14-15 weeks 1
   • Can produce significant improvements in cervical alignment:
     • Reduction in anterior head weight-bearing by approximately 11 mm
     • Increase in Cobb angles by 13-14 degrees
     • Improvement in posterior tangent angles by about 18 degrees

2. Specific Exercises

   • Mirror image neck extension exercises 2
   • Postural correction exercises
   • Strengthening of deep neck flexors and extensors

3. Manual Therapy

   • Spinal manipulation targeting specific segments 3
   • Soft tissue techniques for associated muscle tension

Supportive Interventions

• Postural education and ergonomic modifications
• Temporary use of cervical orthoses in acute phases
• Figure-8 clavicle braces for patients with forward head posture 4

When to Consider Surgical Intervention

Surgical intervention should be considered when:

1. Conservative management fails after 3-6 months 5
2. Progressive neurological deficits occur 5
3. Severe or intractable pain persists 5

Surgical Options

1. Anterior Cervical Discectomy and Fusion (ACDF)

   • Recommended for patients with cervical radiculopathy 5
   • Provides better long-term outcomes compared to laminectomy alone 5
   • Addition of a cervical plate is recommended to:
     • Reduce risk of pseudarthrosis 6
     • Maintain lordosis 6
     • Improve arm pain in 2-level cervical disc degeneration 6

2. Cervical Arthroplasty

   • Recommended as an alternative to ACDF in selected patients 6, 5
   • May decrease the incidence of adjacent segment degeneration by preserving motion 5

3. Laminoplasty with Fusion

   • Recommended for patients with cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL) 6
   • Helps maintain stability and prevents kyphotic deformity 6

Treatment Algorithm

1. Initial Assessment

   • Radiographic evaluation to quantify the degree of abnormal lordosis
   • Assessment of neurological symptoms
   • Evaluation of pain levels using validated scales (e.g., VAS)

2. Conservative Treatment (3-6 months)

   • Begin with CBP technique including extension-compression traction 1, 2
   • Implement specific exercises and spinal manipulation
   • Monitor progress with follow-up radiographs at 10-14 weeks

3. Decision Point

   • If symptoms resolve and lordosis improves: continue maintenance care
   • If minimal improvement or worsening: consider surgical consultation

4. Surgical Consideration

   • For radiculopathy without myelopathy: ACDF or cervical arthroplasty 6, 5
   • For myelopathy: laminoplasty with fusion 6
   • Instrumentation is necessary to maintain cervical lordosis 5

Important Considerations

• Age and gender differences in cervical lordosis should be taken into account when planning treatment 7
• Males typically have smaller upper cervical lordosis and higher lower cervical lordosis than females 7
• Children have more kyphotic vertebral bodies but more lordotic intervertebral discs compared to adults 7

Monitoring and Follow-up

• Regular radiographic assessment to monitor changes in cervical lordosis
• Long-term follow-up is important as improvements can be maintained for at least 14 months after treatment 1
• Monitor for complications after surgery including pseudarthrosis, adjacent segment disease, and dysphagia 5

Pitfalls to Avoid

1. Treating only symptoms without addressing structural abnormalities

   • Correction of cervical lordosis is essential for long-term resolution 3, 2

2. Delaying treatment in progressive cases

   • Early intervention may prevent further degeneration and neurological compromise 5

3. Overlooking the relationship between cervical and thoracolumbar alignment

   • Correction of cervical alignment may have positive effects on other spinal regions 4

4. Ignoring age and gender differences

   • Treatment should account for normal variations in cervical lordosis based on age and gender 7