CERVICAL SPINAL KYPHOTIC DEFORMITY

Cervical spine kyphotic deformities are common sequelae of degenerative disease. Patients may present with a combination of symptoms including myelopathy and radiculopathy. We retrospectively studied a cohort of 78 patients who underwent decompression and reconstruction of the cervical spine for such deformities. Decompression and reconstruction were done by vertebrectomy (51%), multilevel interbody arthrodesis (40%), posterior decompression and reconstruction (4%), and circumferential surgery (5%). 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). For patients requiring revision surgery, 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). 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 decompression and stabilization. In patients whose pretreatment deformity is -15 degrees or greater, strong consideration should be given to circumferential decompression and reconstruction with internal fixation and arthrodesis.