Dream Cheeky will help you know How To Fix Cervical Kyphosis 2022: Things To Know
1. Management principles
As described previously, the broad focus of the treatment of cervical spine deformity correction is to relieve pain, improve alignment of neck, and improve or prevent neurological compromise. Factors that play a key role in the planning of treatment include the presence of spinal cord compression, the flexibility of the deformity, previous surgery, the location of the deformity, and the presence of preexisting anterior or posterior fusion .
If the compression is ventral to the spinal cord then it usually requires anterior decompression unless the decompression can be achieved safely by indirect means by deformity correction through a posterior approach (that requires posterior closing wedge osteotomy) . If the anterior column is deficient (either due to infection or tumor), anterior fixation is almost always required . Depending upon the flexibility of deformity, the approach can be planned. If the deformity is flexible and the surgeon is able to achieve the adequate neck extension by manipulation, then an entirely posterior approach can be used for deformity correction . In cases of stiff deformity, fusion of facet joints should be evaluated using CT before deciding further treatment. However, it is imperative to apply cervical traction for a brief period if the desired extension is not achieved or is partially achieved, and if the facet joints are not ankylosed. In practice, the authors applied traction for around seven days before reevaluating the flexibility of deformity. If the surgeon is able to achieve the desired extension, deformity correction can be performed using a posterior approach. Cervical kyphosis is unlikely to improve if no deformity correction is observed after one week of traction . Traction may also be associated with complications such as transient neurological deficits and patient compliance, and is used intraoperatively to aid deformity correction following decompression in anterior surgeries . If the desired extension cannot be achieved, additional anterior release along with posterior instrumentation (if anterior fusion spans more than three levels) may be required.
The location of the deformity also plays an important role in deciding the approach. Focal kyphosis of the cervical spine can be addressed by anterior corpectomy and fusion, while focal kyphosis at the cervicothoracic junction can be managed via posterior pedicle subtraction osteotomy (PSO) at the cervicothoracic junction .
In cases with a history of prior cervical spine surgery, every attempt should be made to obtain the surgical notes in order to determine the intraoperative findings and the type of instrumentation used (if any). A CT scan should be performed to evaluate prior fusion or pseudoarthrosis. If an anterior approach was used previously it may be necessary to approach the cervical spine from the contralateral side, as the scar tissue from previous surgery will make the dissection difficult. However, it is mandatory that an otolaryngologist assesses the vocal cords to ensure adequate mobility preoperatively. In cases where the recurrent laryngeal nerve is injured during prior surgery, a same-side approach should be utilized to prevent injury to the bilateral recurrent laryngeal nerve. If a posterior approach was used in a previous surgery, the wound should be inspected to assess the integrity of the muscles and soft tissue. In cases of dehiscence of muscle cover, consultation with a plastic surgeon should be sought to ensure good soft tissue cover before planning revision surgery. Fig. 2 shows an algorithm for the management of cervical kyphosis.