Cervical Kyphosis
When viewed from the side, the normal cervical spine curves slightly inward. This
inward curve is called lordosis. Kyphosis is a term used to describe a type of abnormal
curve in the spine. A kyphotic curve looks like the letter "C" with the opening
of the C pointing towards the front. This type of curve is the opposite of a normal
lordotic curve, which has the opening facing towards the back. The larger the abnormal
curve, the more serious the problem. Several different conditions can lead to an excessive
kyphosis.
Learn about cervical kyphosis including
- what causes cervical kyphosis
- what problems may be caused by cervical kyphosis
- how surgery is used to treat the condition
Anatomy and Cervical Kyphosis
In order to understand your symptoms and treatment choices, it is helpful to start with
a basic understanding of the anatomy of the spine. This includes becoming familiar with
the various parts that make up the neck and how they work together.
As described earlier, the cervical spine normally has a lordosis, or inward curvature.
Kyphosis is an abnormal condition in the neck in which the normal inward curve reverses.
This 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. The vertebral bodies need to be strong enough to
support the head and keep the normal shape of the spine. 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 there is damage
to any of these three areas, a kyphotic deformity can develop, and the weight of the head
can cause 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 for iatrogenic reasons. "Iatrogenic" means that the
problem happened from the effects of a medical treatment, such as surgery. Kyphosis can
happen after laminectomy surgery. This procedure is done to relieve pressure on the spinal
cord or spinal nerves. During the procedure, the lamina bone that covers the spinal canal
is removed. Sometimes part or all of the facet joints are also removed during the
procedure. This can cause looseness between the problem verterbrae. When this happens, the
spine may begin to tilt forward.
Kyphosis may also happen 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. Similar problems can also arise if the fusion fails
to heal properly (pseudarthrosis). 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. The weight of the head causes the unbalanced forces to push the
neck further and further forward. This slowly leads to a loss of the normal curve and may
end with a 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 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 of 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 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 who have had radiation
therapy to the neck may have altered growth in the cervical vertebrae, leading to future
problems with kyphosis.
Symptoms of Cervical Kyphosis
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 is caused by degenerative changes.
If the kyphosis is 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 is the body's connection to the brain. When it is damaged or
compressed, the body loses some of its ability to function properly. If pressure builds up
on 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 that is not treated may lead to permanent nerve damage. Pressure
on the spinal cord can eventually lead to quadriplegia, paralysis of all four limbs.
Diagnosis of Cervical Kyphosis
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 exactly what
is causing your symptoms. The most common tests used to diagnose cervical kyphosis are
X-ray and MRI.
The typical treatment for congenital kyphosis is surgery. Early surgical intervention
usually produces the best results and can prevent progression of the curve. The type of
surgical procedure will depend on the nature of the abnormality. Conservative treatments
do not have much success at correcting this type of kyphosis. When surgery is not done, it
is critical that the condition is observed and that close medical follow-up is done,
including X-rays and MRI scans. This is to make sure the kyphosis isn't worsening to the
point it causes more serious problems.
Conservative Treatment
Treatment for cervical kyphosis depends largely on whether there is pressure on the
spinal cord. If there is, surgery may be suggested. If the cervical kyphosis is primarily
causing 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
Surgical Treatment
If the kyphosis is flexible, the decision to go ahead with surgery will be based on the
progression of the curve and the amount of pain it causes. If the curve and pain are
minor, surgery may not be recommended-even if the deformity looks unattractive. If the
deformity is severe and the pain is chronic, surgery may be a good option.
Surgery is usually not recommended when the deformity is fixed (inflexible but not
worsening) and if there are no problems with the nerves or spinal cord. If a fixed
deformity is accompanied by neurological problems from pressure on the spinal cord, the
need for surgery is greater. Surgical correction is the most difficult type of treatment
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 is
used to hold the spine in the proper alignment to straighten it. Surgery may require two
procedures done during the same operation. First, surgery to the front of the spine is
done to relieve the pressure on the spinal cord. The second procedure is done through the
back to fuse the spine and prevent the kyphosis from returning.
If the kyphosis is due to ankylosing
spondylitis (AS), the connection between the cervical and thoracic spine is the
problem area. This type of cervical kyphosis is usually a fixed deformity. In AS the discs
between each vertebra of the entire spine calcify and fuse the bones of the spine
together. If there is a cervical kyphosis after AS fuses the spine, the surgeon may need
to do an osteotomy of the fused spine. "Osteo" means bone, and "otomy"
means cut. This procedure involves cutting the front of the spinal column so the surgeon
can straighten the spine. The spinal cord is not cut-only the bones of the vertebrae in
the front of the spinal column.
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