Spine Information
Cervical Kyphosis
Table of Contents
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
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.
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.
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.
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.
| 
