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 to be strong enough 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 be strong.  And the muscles in the back must be able to 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 be congenital, 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 be present, 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 be lost. In extremely severe cases that are left untreated, paralysis from the neck down may even result.

With a kyphotic deformity, the spinal cord may be stretched where 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

Finding the cause of your neck problem begins with a complete history and physical exam. Various diagnostic tests may be ordered to help your doctor determine the exact cause of your symptoms. The most common tests used to diagnose cervical kyphosis are X-rays and MRI.

Treatment Options

The typical treatment for congenital kyphosis is surgery. Early surgical intervention usually produces the best results and can prevent the progression of the curve. The type of surgical procedure will depend on the nature of the abnormality. Conservative treatments do not have much success in correcting this type of kyphosis. When surgery does not occur, the condition must be closely monitored. and follow-ups routinely continue, including X-rays and MRI scans. This ensures that the kyphosis does not get worse to the point it causes more serious problems.

Conservative Treatment

Treatment for cervical kyphosis depends largely on whether pressure exists on the spinal cord. When pressure exists, surgery may be suggested. If the cervical kyphosis causes pain and concern about your appearance, then the doctor may consider trying to control the pain and deformity with a neck brace for a short period of time, pain medications, and a physical therapy program.

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.

Ankylosing Spondylitis

If the source of the kyphosis comes from ankylosing spondylitis (AS), the connection between the cervical and thoracic spine identifies the problem area. In AS, the discs between each vertebra of the entire spine calcify and fuse the bones of the spine together. If a cervical kyphosis appears after AS fuses the spine, the surgeon may conduct an osteotomy of the fused spine. Finally, this procedure involves cutting the front of the spinal column so the surgeon can straighten the spine. Only the bones of the vertebrae in front of the spinal column are cut.