CERVICAL KYPHOSIS

As described earlier, the cervical spine normally has lordosis or inward curvature.  However, kyphosis occurs when the normal inward curve reverses and causes an abnormal forward curve in the cervical spine.

The stability of the cervical spine and its ability to stay in the lordotic position depends on other parts of the spine. Additionally, the vertebral bodies need strength to support the head and keep the normal shape of the spine. Furthermore, the facet joints, ligaments, and soft tissues in the back of the neck and back must remain strong.  And the muscles in the back must resist the effect of gravity pulling the head forward.  If damage to any of these three areas occurs a kyphotic deformity can develop, and the weight of the head can cause a reversal of the normal curvature of the spine.

Causes of Cervical Kyphosis

This condition has several possible causes and can develop in both children and adults.

Iatrogenic Causes

Kyphosis can occur from the effects of surgery, specifically after laminectomy surgery. This procedure relieves pressure on the spinal cord or spinal nerves. During the procedure,  surgeons remove the lamina bone that covers the spinal canal. Sometimes part or all of the facet joints are also removed during the procedure. This can cause looseness between the problem vertebrae. When this happens, the spine may begin to tilt forward.

Kyphosis may also occur after cervical fusion surgery. In this case, the spine will begin to “bend” over the topmost part of the fusion. The forward tilt causes an imbalance that can lead to kyphosis. If the fusion fails to heal properly, similar problems can also arise. Even when a fusion heals normally, kyphosis can occur if the vertebrae heal with improper alignment.

Degenerative Disc Disease

Degeneration of the intervertebral disc can lead to kyphosis in the neck. In older adults, the wear and tear of aging can cause the discs to collapse. This may cause the head to tilt forward, making the neck bend forward too. This process may steadily get worse over many years and cause Adult Kyphosis. The weight of the head causes unbalanced forces to push the neck further and further forward. This slowly leads to a loss of the normal curve and may end with cervical kyphosis. Learn more about degenerative disc disease.

Congenital Defect

Cervical kyphosis can occur by inheritance, which means that you are born with it. A person born with some sort of defect, such as the incomplete formation of part of the spine, may end up with an increasing kyphosis in the neck. Congenital kyphosis usually leads to a growth disturbance of the vertebrae. Instead of growing normally, the vertebrae grow into a triangular shape with the thin end pointing forward. Because the vertebrae are stacked on top of each other, the triangle shape causes the spine to have a forward curvature. When a child has congenital kyphosis, there are generally additional birth defects in other areas of the body, most commonly in the kidneys and urinary system.

Trauma

Cervical kyphosis can occur as the result of an injury to the neck. Vertebral compression fractures cause the vertebral body to collapse into the shape of a wedge. This causes the section of the spine to tip forward, and the resulting imbalance leads to a loss of the normal curvature of the neck. Other injuries that damage the ligaments along the back of the cervical spine can also cause kyphosis. If the kyphosis gets bad enough, it can narrow the spinal canal and put pressure on the spinal cord (spinal stenosis).

Other Causes

Other less common causes of cervical kyphosis include infections or tumors in the spine, systemic (whole-body) diseases that affect the spine such as ankylosing spondylitis, and radiation therapy for cancer in the neck. Children especially those who have had radiation therapy to the neck may have altered growth in the cervical vertebrae, leading to future problems with kyphosis.

Symptoms

The symptoms and severity of kyphosis vary. Symptoms range from minor changes in the shape of your spine to severe deformity, neurologic deficits, and chronic pain. Neck movement may become limited, making it difficult to turn the neck fully or to look up for very long. The abnormal forward curvature can eventually appear unattractive. Neck pain may appear, especially if the kyphosis stems from degenerative changes.

If the kyphosis becomes severe, pressure can occur on the spinal nerve roots or spinal cord. This can cause weakness in the arms or legs, loss of grip strength, or difficulty walking due to spasticity in the legs. Bowel or bladder control may become lost. In extremely severe cases that are left untreated, paralysis from the neck down may even result.

With a kyphotic deformity, the spinal cord can stretch when the spine bends forward. The spinal cord provides the body’s connection to the brain and when damaged or compressed, the body loses some of its ability to function properly. If the pressure builds upon the spinal cord, it can cause myelopathy. Myelopathy may impair normal walking, hand, and finger use, and bowel and bladder function. Doctors take these symptoms very seriously because severe myelopathy may lead to permanent nerve damage. Pressure on the spinal cord can eventually lead to quadriplegia, paralysis of all four limbs.

Diagnosis

Medical History Evaluation

The first step in diagnosing cervical kyphosis involves a comprehensive evaluation of the patient’s medical history. The doctor will inquire about the symptoms experienced, their duration, and any factors that may exacerbate or alleviate them. Additionally, the doctor will ask about any previous injuries, surgeries, or pre-existing medical conditions that may contribute to the development of cervical kyphosis. Understanding the patient’s medical history provides valuable insights into potential causes and guides further diagnostic investigations.

Physical Examination

Following the medical history evaluation, a thorough physical examination is conducted to assess the patient’s range of motion, posture, and any visible abnormalities. The doctor will carefully observe the neck curvature, looking for signs of abnormal forward curvature or loss of the natural cervical lordosis. They may also evaluate muscle strength, reflexes, and sensory responses in the upper extremities to identify any associated neurological deficits.

Imaging Studies

Imaging studies are essential in confirming the diagnosis of cervical kyphosis and assessing its severity. The following imaging modalities are commonly used:

• X-rays: X-rays provide a two-dimensional view of the cervical spine, allowing doctors to assess the alignment, curvature, and overall condition of the vertebrae. X-rays can reveal abnormal forward curvature, loss of lordosis, or other structural abnormalities that may contribute to cervical kyphosis. Dynamic X-rays, taken while the patient moves their neck, can provide additional information on the flexibility and stability of the cervical spine.
• Magnetic Resonance Imaging (MRI): An MRI scan utilizes powerful magnets and radio waves to create detailed images of the soft tissues, discs, nerves, and spinal cord. It helps identify any underlying causes of cervical kyphoses, such as herniated discs, spinal cord compression, or spinal cord abnormalities. Additionally, MRI can reveal degenerative changes, inflammation, or tumors that may contribute to the curvature.
• Computed Tomography (CT) Scan: CT scans utilize X-rays and advanced computer technology to produce cross-sectional images of the cervical spine. CT scans are particularly useful in assessing bony structures, such as identifying fractures, bone spurs, or abnormalities in the vertebrae. They can provide detailed information about the precise location and extent of any bony abnormalities contributing to cervical kyphosis.

Additional Diagnostic Tests

In some cases, your doctor may require additional diagnostic tests to evaluate the functional impact of cervical kyphosis or to rule out other underlying conditions. These tests may include:

• Electromyography (EMG): EMG involves the measurement of electrical activity in the muscles. It can help determine if there are any nerve root or peripheral nerve abnormalities contributing to muscle weakness or sensory deficits.
• Nerve Conduction Studies: Nerve conduction studies assess the speed and strength of electrical signals as they travel through the nerves. This test can identify any nerve damage or dysfunction that may associate with cervical kyphosis.
• Blood Tests: Blood tests may rule out certain medical conditions that could contribute to spinal abnormalities, such as infections, inflammatory diseases, or metabolic disorders.

Treatment Options

Non-Surgical Treatment Options:

• Physical Therapy: Physical therapy plays a crucial role in the non-surgical management of cervical kyphosis. A skilled physical therapist will design a personalized exercise program to strengthen the neck muscles, improve flexibility, and promote better posture. These exercises can help alleviate pain, enhance stability, and enhance the range of motion in the cervical spine.
• Pain Management: In cases where cervical kyphosis causes significant pain and discomfort, your doctor will implement pain management techniques. Nonsteroidal anti-inflammatory drugs (NSAIDs) or muscle relaxants can help reduce inflammation and relieve muscle spasms. Additionally, the use of heat or cold therapy, transcutaneous electrical nerve stimulation (TENS), or ultrasound therapy may provide temporary relief.
• Bracing: For individuals with mild cervical kyphosis, our doctors may recommend wearing a cervical brace or collar. These devices help provide external support and restrict neck movement, allowing the spine to heal and gradually regain proper alignment. Bracing is often used in combination with physical therapy to achieve the best results.

Surgical Treatment Options:

• Decompression and Fusion: In cases where non-surgical methods fail to improve symptoms or when cervical kyphosis is severe, surgical intervention may be necessary. One common surgical procedure is decompression and fusion. During this procedure, the surgeon removes any bone spurs, herniated discs, or other structures that may be compressing the spinal cord or nerves. The affected vertebrae are then fused together using bone grafts or implants to restore stability and alignment.
• Osteotomies: In certain situations, cervical kyphosis may require more extensive surgical correction, such as osteotomies. This procedure involves removing a wedge-shaped piece of bone from the vertebrae to allow for realignment. Osteotomies are typically performed in severe cases of cervical kyphosis where the abnormal curvature is significant.
• Artificial Disc Replacement: Another surgical option for cervical kyphosis is artificial disc replacement. This procedure involves replacing a damaged or diseased disc in the cervical spine with an artificial disc implant. Artificial disc replacement aims to preserve motion in the cervical spine while correcting abnormal curvature. This procedure is typically reserved for select cases and requires careful patient selection.

Post-Surgical Rehabilitation: Following surgery, a comprehensive rehabilitation program is crucial for optimal recovery. Physical therapy is typically prescribed to improve strength, flexibility, and range of motion. Rehabilitation aims to help patients regain function, adapt to the changes in the spine, and prevent future complications.

Physical Therapy

Your doctor may have you work with a physical therapist. A well-rounded rehabilitation program assists in calming pain and inflammation, improving your mobility and strength, and helping you do your daily activities with greater ease and ability.

Exercise has not proven helpful for changing the kyphotic curve in the neck. However, it can be helpful in providing pain relief. Therapy sessions may be scheduled two to three times each week for up to six weeks.
The goals of physical therapy are to help you

• learn correct posture and body movements to counteract the effects of kyphosis
• maintain appropriate activity levels
• maximize your neck range of motion and strength
• learn ways to manage your condition

Learn more about spinal rehabilitation.

Surgical Treatment

If the kyphosis appears flexible, the decision to conduct surgery will depend on the progression of the curve and the amount of pain incurred. If the curve and pain are minor, surgery may not be recommended even if the deformity looks unattractive.  Often, if the deformity appears severe and chronic pain exists, surgery may be a good option.

Doctors do not usually recommend surgery when the deformity appears fixed (inflexible but not worsening) and if there are no problems with the nerves or spinal cord. On the other hand, if a fixed deformity has problems from pressure on the spinal cord, the need for surgery becomes greater. To clarify, a surgical correction is a very difficult type of treatment and one that only skilled surgeons should perform for cervical kyphosis.

Surgery to treat cervical kyphosis usually involves spinal fusion combined with segmental instrumentation. This means that some type of metal (titanium) plate or rod holds the spine in the proper alignment to straighten it. Surgery may require two procedures during the same operation. First, surgery to the front of the spine will relieve the pressure on the spinal cord. The second procedure,  done through the back, fuses the spine and prevents kyphosis from returning.

Why Choose Southwest Scoliosis and Spine Institute

Part of diagnosing, evaluating and treating a patient with cervical kyphosis requires a number of variables. Along with the patient’s age, curvature location, and type of scoliosis, Regardless of severity, the sooner treatment starts, the better the prognosis for treatment. Unfortunately, a cure for cervical kyphosis does not exist, but the tools exist to treat it.   At The Southwest Scoliosis and Spine Institute, with offices in Dallas, Plano, and Frisco, Texas, we tailor each and every treatment plan to suit the specifics of each patient’s condition.

We employ a variety of treatment modalities so that our patients may receive various types of care, and we also refer patients for physical therapy, rehabilitation, and corrective bracing specifically for cervical kyphosis. As we work with a patient during the course of their treatment, we keep track of how they are progressing and adjust the treatment plan as needed based on their condition. If you are in pain, call us to make an appointment.

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Medical News Today: Cervical Kyphosis