Management of Cervical Kyphotic Deformity

ABSTRACT

Cervical spinal kyphotic deformities are common sequelae of degenerative disease and/or prior posterior decompressive surgery. Patients may present with myelopathy, radiculopathy, cervicalgia, dysphagia, or a combination thereof. Treatment of cervical kyphotic deformities involves decompression of the spinal cord at regions of stenosis followed by reconstruction of the spine to reduce the deformity and to reconstruct and stabilize the spine.

We prospectively studied a cohort of 78 patients who underwent decompression and reconstruction of the cervical spine for kyphotic deformities. Common etiologies included degenerative disease, trauma, osteomyelitis, and postlaminectomy angulation. Decompression and reconstruction were done by vertebrectomy/strut graft (51%), multilevel interbody arthrodesis (40%), posterior decompression and reconstruction with arthrodesis (4%), or combined ventral and dorsal procedures (5%). Fourteen patients (18%) had failure of their initial reconstruction graft and/or fixation requiring surgical revision via a combined approach.

For those patients requiring revision, the average degree of pretreatment kyphosis was -25.1 ± 16.6 degrees compared with -12.4 ± 10.0 degrees preoperative angulation for those patients who were effectively treated via their primary procedure (p < 0.001, unpaired t-test). In those patients whose pretreatment kyphotic deformity was more severe than -15 degrees, 10 of 27 required revision compared with only 4 of 51 patients whose initial deformities were less than -15 degrees (p < 0.005, Fisher exact test). Overall, myelopathy improved in 83% of treated patients, radiculopathy improved in 94%, and cervicalgia improved in 70%. The mean preoperative kyphosis was -14.6 degrees, which was improved to a mean postoperative lordosis of +5.3 degrees.

For patients with symptomatic cervical kyphotic deformity, consideration should be given to treatment by decompression, stabilization, and arthrodesis. In those patients with a pretreatment deformity of -15 degrees or greater, strong consideration should be given to a combined ventral/dorsal decompression-internal fixation-fusion procedure.

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