What is the treatment for straightening of cervical lordosis?

Treatment of Straightening of Cervical Lordosis

For symptomatic loss of cervical lordosis, conservative treatment with cervical extension traction combined with physical therapy is the first-line approach, with surgical intervention (anterior cervical discectomy and fusion with plating) reserved for patients with progressive neurological deficits or failure of conservative management after 3 months. 1

Initial Conservative Management

Non-Surgical Treatment Protocol

• Begin with cervical extension traction methods for 5-15 weeks (15-60 treatment sessions), which can restore lordosis by 12-18° in patients with hypolordosis 2
• Add short-term muscle relaxants (up to 2-3 weeks maximum) for associated muscle spasm 1
• Implement physical therapy focusing on exercises to strengthen neck muscles and improve posture 1
• Use anti-inflammatory medications to reduce pain and inflammation 1
• Apply hot/cold therapy for temporary pain relief 1
• Modify activities to avoid positions that worsen symptoms 1

Evidence for Conservative Approach

The systematic review evidence demonstrates that cervical extension traction as part of spinal rehabilitation reduces pain and disability with long-term maintenance of improvements up to 1.5 years, while comparative groups without lordosis restoration experienced symptom regression by 1 year 2. Specific techniques like Chiropractic Biophysics extension-compression traction combined with manipulation achieved 13-18° improvements in cervical lordosis over 14.6 weeks, with maintained results at 14-month follow-up 3.

Surgical Indications and Timing

When to Consider Surgery

Refer for surgical evaluation if any of the following are present: 1

• Progressive neurological deficits
• Failure to respond to conservative treatment after 3 months
• Signs of cervical myelopathy (difficulty with fine motor skills, gait disturbances)
• Evidence of significant spinal cord compression on imaging

Surgical Options Based on Pathology

For 1-level cervical disc degeneration:

• Anterior cervical discectomy and fusion (ACDF) with plating is recommended to maintain lordosis (Class II evidence, strength C) 4
• The addition of cervical plate reduces risk of pseudarthrosis and graft problems, and specifically maintains lordosis 4
• Cervical arthroplasty is an alternative for selected patients for control of neck and arm pain (Class II evidence, strength B) 4

For 2-level cervical disc degeneration:

• ACDF with instrumentation (plating) is recommended over ACDF alone to improve arm pain (Class II evidence, strength C) 4

For 3-segment disease:

• Anterior corpectomy is recommended, though pseudarthrosis occurs in approximately 10.9% of cases 1

For multilevel degenerative myelopathy:

• Laminoplasty preserves motion and reduces axial neck pain 1
• Laminectomy with fusion prevents post-laminectomy kyphosis, which occurs in approximately 10% of patients after laminoplasty alone 4, 1

Critical Clinical Considerations

Prognostic Factors

• Development of kyphosis predicts poor outcomes in patients with cervical spine conditions (p < 0.05) 4, 5
• Patients who developed kyphosis (-12.5°) had worse clinical outcomes compared to those who maintained lordosis (+1.1°) 4
• ACDF is recommended over anterior cervical discectomy alone to reduce the risk of kyphosis and increase fusion rate (Class II evidence, strength C) 4

Surgical Complications to Monitor

• C5 nerve palsy can develop after surgery, especially when laminae are elevated to an angle >60° during laminoplasty 4, 1
• Post-surgical kyphosis occurs in approximately 10% of patients after laminoplasty 4, 1
• Pseudarthrosis should be evaluated if clinical outcome is poor, as arthrodesis is associated with improved clinical outcome (Class III evidence, strength D) 4

Important Caveats

• Long periods of severe stenosis can lead to potentially irreversible spinal cord damage 1
• Cervical spondylosis often has a mixed progression with periods of stability 1
• While ACDF with plating maintains lordosis better than ACDF alone, plating does not necessarily improve clinical outcome alone for 1-level disease (Class II evidence, strength B) 4