Cervical Kyphosis In Patients Research Articles

Surgical Treatment Outcomes of Anterior-Only Correction and Reconstruction for Severe Cervical Kyphotic Deformity with Neurofibromatosis-1: A Retrospective Study with a 5-Year Follow-Up.

Currently, anterior-only (AO), posterior-only, and combined anterior-posterior spinal fusions are common strategies for treating cervical kyphosis in patients with neurofibromatosis-1 NF-1. Nevertheless, the choice of surgical strategy remains a topic of controversy. The aim of our study is to evaluate the safety and effectiveness of anterior decompression and spinal reconstruction for the treatment of cervical kyphosis in patients with NF-1. Twelve patients with NF-1-associated cervical kyphotic deformity were reviewed retrospectively between January 2010 and April 2020. All patients underwent AO correction and reconstruction. The X-ray was followed up in all these patients to assess the preoperative and postoperative local kyphosis angle (LKA), the global kyphosis angle (GKA), the sagittal vertical axis, and the T1 slope. The visual analog scale score, Japanese Orthopedic Association (JOA) score, and neck disability index (NDI) score were used to evaluate the improvement inclinical symptoms. The results of the difference in improvement from preoperatively to the final follow-up assessment were assessed using a paired t-test or Mann-Whitney U-test. The LKA and GKA decreased from the preoperative average of 64.42 (range, 38-86) and 35.50 (range, 10-81) to an average of 16.83 (range, -2 to 46) and 4.25 (range, -22 to 39) postoperatively, respectively. The average correction rates of the LKA and GKA were 76.11% and 111.97%, respectively. All patients had achieved satisfactory relief of neurological symptoms (p < 0.01). JOA scores were improved from 10.42 (range, 8-16) preoperatively to 15.25 (range, 11-18) at final follow-up (p < 0.01). NDI scores were decreased from an average of 23.25 (range, 16-34) preoperatively to an average of 7.08 (range, 3-15) at the final follow-up (p < 0.01). Anterior-only correction and reconstruction is a safe and effective method for correcting cervical kyphosis in NF-1 patients. In fixed cervical kyphosis cases, preoperative skull traction should also be considered.

Incidence of cervical kyphosis and cervical posterior translation in neck pain associated with radiological evidence of degenerative disc disease

BackgroundCervical kyphosis mechanically influences the intervertebral discs, which may lead to neck, shoulder, and scapular pain. ObjectivesTo investigate the incidence of cervical kyphosis and posterior displacement of cervical vertebrae (cervical posterior translation index) in patients with radiologically evident degenerative disc disease. DesignRetrospective-cohort study. MethodsNinety-five patients with radiologically evident degenerative disc disease were recruited at our clinic from 2015 to 2019. Radiography images were used to analyze the straight-line index in each patient in the upright posture. The straight-line index was calculated by drawing a reference line connecting the posterior inferior edges of C2 to C7 and normalizing the addition of the distances from the posterior inferior edges of C3, C4, C5, and C6 to the reference line, respectively. Straight-line index <0 was defined as cervical kyphosis and ≥0 as cervical lordosis, the cervical kyphosis. In cervical kyphosis group, the distance from the posterior inferior edges of C3, C4, C5, and C6 to the reference line was normalized by the reference line distance to determine posterior displacement. Multiple comparison tests aside from simple and multiple linear regression analysis were performed. ResultsThe incidence of cervical kyphosis in patients with radiologically evident degenerative disc disease was 60% (57/95 patients). Multiple comparison tests revealed that the cervical posterior translation indexes of C4 and C5 were significantly higher than those of C3, C4, and C6, in cervical kyphosis group. ConclusionsCervical kyphosis was present in 60% of patients with radiologically evident degenerative disc disease, with C5 showing the most posterior displacement.

Halo traction combined with posterior-only approach correction for cervical kyphosis with Neurofibromatosis-1: minimum 2\u2009years follow-up

BackgroundSurgical management of cervical kyphosis in patients with NF-1 is a challenging task. Presently, anterior-only (AO), posterior-only (PO) and combined anterior-posterior (AP) spinal fusion are common surgical strategies. However, the choice of surgical strategy and application of Halo traction remain controversial. Few studies have shown and recommended posterior-only approach for cervical kyphosis correction in patients with NF-1. The aim of this study is to evaluate the safety and the effectiveness of halo Traction combined with posterior-only approach correction for treatment of cervical kyphosis with NF-1.MethodsTwenty-six patients with severe cervical kyphosis due to NF-1 were reviewed retrospectively between January 2010 and April 2018. All the cases underwent halo traction combined with posterior instrumentation and fusion surgery. Correction result, neurologic status and complications were analyzed.ResultsIn this study, cervical kyphosis Cobb angle decreased from initial 61.3 ± 19.7 degrees to postoperative 10.6 ± 3.7 degrees (P<0.01), with total correction rate of 82.7%, which consist of 45.8% from halo traction and 36.9% from surgical correction. JOA scores were improved from preoperative 13.3 ± 1.6 to postoperative 16.2 ± 0.7 (P<0.01). Neurological status was also improved. There was no correction loss and the neurological status was stable in mean 43 months follow-up. Three patients experienced minor complications and one patient underwent a second surgery.ConclusionHalo traction combined with PO approach surgery is safe and effective method for cervical kyphosis correction in patients with NF-1. A satisfied correction result, and successful bone fusion can be achieved via this procedure, even improvement of neurological deficits can also be obtained. Our study suggested that halo traction combined with PO approach surgery is another consideration for cervical kyphosis correction in patients with NF-1.

Cervical kyphosis in patients with thoracic idiopathic scoliosis.

Cervical kyphosis in patients with thoracic idiopathic scoliosis.

Early and Midterm Outcomes of Surgical Correction for Severe Dystrophic Cervical Kyphosis in Patients with Neurofibromatosis Type 1: A Retrospective Multicenter Study

To evaluate the early and midterm outcomes of surgical correction for severe dystrophic cervical kyphosis in patients with neurofibromatosis type 1 (NF-1) and analyze the pathomechanics and the influence on surgical efficacy of related systemic skeletal dystrophy. Ten patients who underwent surgical correction for NF-1-related severe dystrophic cervical kyphosis were reviewed. Radiographic parameters, including local and global Cobb angle, sagittal vertical axis, and T-1 slope, were measured. The visual analog scale score, Japanese Orthopaedic Association score, Neck Disability Index, Patient Satisfaction Index, and complications were evaluated. The average follow-up was 50.6 months. The local and global Cobb angle improved from the preoperative average of 82.0° and 54.9° to an average of 35.6° and 29.8°, respectively, at the time of final follow-up. The C2-7 sagittal vertical axis averaged 5.8 mm before surgery and 8.9 mm at the final follow-up. The average T1 slope was -12.3° before surgery and -1.6° at the final follow-up. The visual analog scale score, Japanese Orthopaedic Association score, and Neck Disability Index improved significantly, and the overall satisfaction rate was 90.0%. One death and 4 instrumentation failures occurred, 3 patients showed progression of the kyphosis, and 2 fusion failures were observed. Surgical correction, specifically the combined anteroposterior procedure, is essential and effective for management of NF-1-related severe dystrophic cervical kyphosis. However, high incidences of instrumentation failure, kyphosis progression, and fusion failure were observed. NF-1-related continuous skeletal dystrophy caused by multiple metabolic factors remarkably affected the midterm outcomes. Early prevention and targeted pharmacotherapy may be necessary.

Mid-term clinical outcomes and radiological results of anterior cervical surgery for Hirayama disease

Objective To evaluate the effect of anterior cervical fusion or non-fusion surgery for the treatment of Hirayama disease. Methods The patients with Hirayama disease who underwent anterior cervical surgery in our hospital from July 2008 to December 2015 were retrospectively enrolled in this study. These cases were divided into two groups: fusion group (11 cases) and non-fusion group (12 cases). In fusion group, there were 9 males and 2 females, with an average age of 17.92±0.61 years (range, 15-29). In the non-fusion group, there were 10 males and 1 female, with an average age of 19.18±1.14 years (range, 15-23). Muscle strength, muscular atrophy, and the Michigan score for hand function were compared between the two groups preoperatively and postoperatively. The indexes such as arc cervical physiological curvature index, the maximum flexion angle, the maximal range of motion (ROM), flexion ROM of adjacent segments of lower cervical vertebra were measured from the X-ray of the two groups, and the cross-sectional area of spinal cord was measured and compared on neutral position MRI. Results There were no significant differences between the two groups in grip strength, preoperative hand function Michigan score, cervical physiological curvature index, the maximum flexion angle, the maximal ROM, flexion ROM of adjacent segments of lower cervical vertebra, and cross-sectional area of spinal cord on neutral position MRI (P>0.05). Patients in fusion group were followed up for 38-103 months with an average of 59.73±5.57 months, while patients in non-fusion group were followed up for 40-95 months with an average of 56.25±4.57 months. Clinical outcomes: At the last follow-up, the finger tremor and cold paralysis were alleviated in all patients, but the symptoms in fusion group and non-fusion group were not completely disappeared in 2 and 3 cases, respectively. The grip strength of fusion group (preoperative 17.14±6.09, postoperative 17.47±5.64) and the non-fusion group (preoperative 17.75±5.49, postoperative 17.40±4.58) were not significantly improved compared with preoperative (P>0.05). The Michigan score for hand function of fusion group (preoperative 10.27±0.41, postoperative 6.64±0.24) and the non-fusion group (preoperative 9.25± 0.35, postoperative 6.83±0.24) were significantly improved compared with preoperative (P 0.05). Radiological outcomes: The cervical physiological curvature index and cross-sectional area of the spinal cord of the two groups increased after operation, while the maximum flexion angle, the maximal ROM decreased. There was no significant difference in these indexes between the two groups postoperatively (P>0.05). The spinal cord had no compression on flexion MRI. The cross-sectional area of C4-C7 spinal cord in Neutral MRI were significantly increased at C6 and C7 levels in both groups. There was no significant difference in the cross-sectional area of C4-C7 spinal cord between the two groups postoperatively (P>0.05). Two cases of internal fixation loosening occurred in non-fusion group 3 years after the operation, while there were no cases of loosening in the fusion group. Conclusion Anterior cervical fusion or non-fusion surgery can limit excessive cervical kyphosis in patients with Hirayama disease, reduce atrophy of compressed cervical spinal cord, and alleviate the disease progress of muscular atrophy of the distal upper limb. It can be selected as a treatment method for Hirayama disease. However, there is a risk of internal fixation loosening in non-fusion cases, and also a risk of adjacent segment degeneration in fusion cases. The appropriate cases should be selected carefully for surgery. Key words: Cervical vertebrae; Spinal cord compression; Upper extremity; Muscular atrophy; Spinal fusion

Incidence and Risk Factors of Cervical Kyphosis in Patients with Adolescent Idiopathic Scoliosis

Cervical kyphosis (CK) has been reported in patients with adolescent idiopathic scoliosis (AIS). The report about the incidence of CK between patients with AIS and normal populations was little. Patients included in previous studies often required scoliosis surgery (Cobb angle ≥40°), which does not represent all patients with AIS. The aims of this study were to compare incidence of CK between patients with AIS (Cobb angle >10°) and an age-matched normal population and to identify risk factors related to CK, especially coronal parameters that have rarely been studied in current literature. Patients with AIS (n= 112) and asymptomatic subjects from the general population (control group; n= 40) were retrospectively analyzed. Radiographic parameters of coronal and sagittal plane were measured on full-length spine x-rays. Patients with AIS were divided into 2 groups based on cervical lordosis angle: cervical lordosis and CK. CK was observed in 14 of 40 (35%) subjects in the control group and 68 of 112 (60.7%) patients with AIS. Several parameters were related to CK, including major curve, proximal thoracic, and main thoracic Cobb angle; proximal thoracic kyphosis angle; main thoracic kyphosis angle; T1 slope; sagittal vertical axis; vertical distance between C7 plumb line and center sacral vertical line; apical vertebral translation; T1 coronal tilt; and lumbar pelvic relationship. Logistic regression identified main thoracic Cobb angle, main thoracic kyphosis angle, sagittal vertical axis, lumbar pelvic relationship, and apical vertebral translation as independent risk factors of CK. Incidence of CK increases in patients with AIS relative to normal subjects. Coronal parameters of the spine could influence cervical sagittal alignment.

Cervical Kyphotic Deformity after Laminoplasty in Patients with Cervical Ossification of Posterior Longitudinal Ligament with Normal Sagittal Spinal Alignment

Background Preoperative cervico-thoracic kyphosis and cervical regional positive imbalance are the risk factors for postoperative cervical kyphosis after expansive laminoplasty (ELAP). However, the relationship between preoperative global sagittal spinal alignment and postoperative cervical kyphosis in patients with cervical ossification of the posterior longitudinal ligament (OPLL) is unclear. The purpose of this study was to investigate the relationship between the onset of postoperative cervical kyphosis after ELAP and the preoperative global spinal sagittal alignment in patients with OPLL with normal sagittal spinal alignment. Methods Sixty-nine consecutive patients without preoperative cervical kyphosis who underwent ELAP for OPLL and cervical spondylotic myelopathy (CSM) were enrolled. The global sagittal alignment radiography preoperatively and 1 year postoperatively were examined. The subjects were divided into a postoperative cervical lordosis group (LG) or a kyphosis group (KG) at 1 year postoperatively. The preoperative global sagittal spinal alignment between LG and KG in CSM and OPLL was compared. Results The occurrence of cervical kyphosis after ELAP was 7 of 27 cases (25.9%) in OPLL and 13 of 42 cases (31.0%) in CSM. In patients with CSM in the KG, C7 the sagittal vertical axis (SVA) was smaller than in the LG. In patients with cervical OPLL in the KG, C2-C7 angle, C2-C7 SVA, and thoracic kyphosis (TK) were smaller than those in the LG. In OPLL, the age of the KG was younger than that of LG; however, this was not a significant difference in CSM. Conclusion In patients with cervical OPLL without preoperative global spinal sagittal imbalance, preoperative small C2-C7 angle, C2-C7 SVA, TK, and younger age were typical characteristics of postoperative cervical kyphosis after ELAP.

Cervical kyphosis in patients with Lenke type 1 adolescent idiopathic scoliosis: the prediction of thoracic inlet angle

BackgroundSeveral studies have explored cervical kyphosis (CK) in adolescent idiopathic scoliosis (AIS) patients. However, few studies have evaluated the cervical alignment in these patients according to their coronal curve type. The aim of this study was to analyze the radiological features of cervical sagittal alignment in Lenke 1 AIS patients before and after surgery.MethodsThis is a retrospective study enrolled 50 patients. Preoperative and postoperative standing full-length radiographs (at last follow-up after operation) were used to measure the coronal and sagittal parameters. Main sagittal parameters included C2–C7 angle, thoracic inlet angle (TIA), T1 slope, proximal thoracic kyphosis (PTK, T1-5 kyphosis) and thoracic kyphosis (TK, T5-12 kyphosis).ResultsThe TIA of patients with CK was significantly smaller than that of patients with CL (63.0° vs. 76.3°, p < 0.05) and the cutoff value was 71°. The TIA of patients with CK after surgery was significantly smaller than that of patients with CL postoperatively (62.5° vs. 74.6°, p < 0.05) and the cutoff value was 62°. In patients with postoperative CL, there was a significant increase in their PTK and a reduction in their TK, regardless of preoperative CL or CK. In patients whose CL deteriorated to CK after surgery, both their PTK and TK significantly decreased after surgery.ConclusionsPatients with TIA less than 71° were more likely to have CK. And patients with TIA less than 62° would lead to the postoperative uncorrected or new onset of CK. The increased PTK after operation could have a beneficial effect on the improvement of CL.

Surgical correction of severe cervical kyphosis in patients with neurofibromatosis Type 1

Severe cervical kyphosis requiring surgical treatment is rare in patients with neurofibromatosis Type 1 (NF1). When it occurs, however, dystrophic changes in the vertebrae make surgical correction and fusion of the deformity extremely difficult. The authors report on 3 cases of severe cervical kyphosis associated with NF1 that were successfully treated with combined anterior and posterior correction and fusion. All patients underwent halo-gravity traction for approximately 1 month prior to surgery to correct the deformity gradually. Posterior correction and fusion were performed with segmental spinal instrumentation consisting of lateral mass screws, lamina screws, pedicle screws, and polyethylene tape for sublaminar wiring. Anterior spinal fusion was performed using a fibula strut to induce solid bone fusion. All patients used a halo vest for postoperative external fixation. Preoperative CT scans showed dystrophic cervical spine changes, and MR images demonstrated extensive neurofibromas outside the cervical spine in all 3 patients. The preoperative kyphotic angles were as follows: Case 1, 140°; Case 2, 81°; and Case 3, 72°; after halo-gravity traction, the kyphosis angles improved to 50°, 55°, and 51°, respectively; and after surgery, they were 50°, 15°, and 27°, respectively. Solid bone union was observed in all patients at the latest follow-up. All three patients experienced postoperative complications consisting of superficial infection, severe pneumonia, and partial dislocation of the distal fibula graft after removing the halo vest, in one patient each. Although dystrophic cervical vertebral changes in these patients with NF1 complicated the correction of severe cervical kyphosis, the use of preoperative halo-gravity traction, a combination of spinal instrumentations, an anterior strut bone graft, and postoperative halo-vest fixation made it possible to correct the kyphosis, maintain the correction, and achieve solid bone fusion.

Review of Cervical Kyphosis in Larsen Syndrome

Our objective was to review surgical treatment options and outcomes for cervical kyphosis in patients with Larsen syndrome. Cervical kyphosis in patients with Larsen syndrome may lead to paralysis or death from spinal cord impingement at the apex of kyphosis. Proper screening and early diagnosis followed by operative stabilization have been recommended. We reviewed the literature for surgical treatment of cervical kyphotic deformity in patients with Larsen syndrome. We retrospectively reviewed medical records and used illustrative case examples to demonstrate the scenarios and treatments. Over the past 23 years, we have surgically treated many patients with Larsen syndrome who had cervical kyphosis. We have several patients who were treated initially elsewhere with posterior spinal fusion, but who required revisions for cervical kyphoses because of progression of the deformity or spinal cord impingement. This report discusses 3 illustrative patients presenting with cervical kyphoses associated with Larsen syndrome, who were initially treated with posterior spinal fusions at a young age, but required an anterior or posterior spinal fusion as a second procedure to correct non-improving progression of the deformities and spinal cord impingement. Cervical kyphosis in Larsen syndrome is a rare condition that can progress to cervical stenosis and spinal cord impingement, which may lead to paralysis or death. Several patients who were treated initially with posterior spinal fusion only required revision surgeries.

Use of hinged rods for controlled osteoclastic correction of a fixed cervical kyphotic deformity in ankylosing spondylitis

Cervical kyphosis in patients with ankylosing spondylitis (AS) can be severely disabling. Surgical treatment of this disorder is technically demanding, however, with a considerable risk of neurological and vascular injuries. The extension osteotomy is a well-described posterior treatment for this condition, but this approach presents the risk of acute subluxation and spinal column translation during the reduction. In this paper, the authors report the novel use of a hinged posterior cervical rod for controlled correction of cervical kyphosis. After sustaining a traumatic spinal fracture, a 57-year-old man with AS developed a delayed cervical flexion deformity. The patient was neurologically intact, but suffered from disabling impairment in horizontal gaze and activities of daily living, and from neck pain. The patient subsequently underwent surgical correction via a posterior cervical extension osteotomy at C7-T1 with manual extension of the neck for osteoclastic reduction of the cervical kyphosis. Controlled correction was performed by using a hinged rod affixed to posterior cervical and thoracic screws, allowing for free sagittal correction while restricting translational forces. Once the desired angle of correction was achieved, the hinge connector was locked, transforming the rod into a rigid device for permanent internal fixation. The use of hinged rods in cervical kyphosis correction provides a controlled method for reduction at the osteotomy site, decreasing the risk of neurological injury.

Cervical Kyphosis Associated With Anteroposterior Dissociation and Quadriparesis in Larsenʼs Syndrome

Neither the natural history nor the optimal treatment of cervical spine anomalies in Larsen's syndrome has been clearly defined. The authors describe two patients with Larsen's syndrome with cervical kyphosis, anteroposterior dissociation, and quadriparesis to show the variable clinical progression and offer a description of the authors' treatment. One patient has had continued neurologic and radiographic improvement with nonoperative treatment consisting of early traction. The other patient was treated with posterior fusion that failed to halt progressive kyphosis of the anterior vertebral bodies because of anteroposterior dissociation. He then was treated by resection of the posterior fusion, traction, and anterior and posterior decompression and fusion. Cervical kyphosis in patients with Larsen's syndrome is unpredictable, and both nonoperative and operative treatments have the potential to be successful. Anteroposterior dissociation of the cervical spine may be more common in Larsen's syndrome than recognized previously and may profoundly affect operative strategy and outcome.

Cervical Kyphosis Is a Possible Link to Attention-Deficit/Hyperactivity Disorder

Objective To discuss the case of a patient who was diagnosed with attention-deficit/hyperactivity disorder (ADHD) by a general practitioner and was treated with chiropractic care. Clinical Features A 5-year-old patient was diagnosed with ADHD and treated by a pediatrician unsuccessfully with methylphenidate (Ritalin), Adderall, and Haldol for 3 years. The patient received 35 chiropractic treatments during the course of 8 weeks. A change from a 12° C2-7 kyphosis to a 32° C2-7 lordosis was observed after treatment. During chiropractic care, the child's facial tics resolved and his behavior vastly improved. After 27 chiropractic visits, the child's pediatrician stated that the child no longer exhibited symptoms of ADHD. The changes in structure and function may be related to the correction of cervical kyphosis. Conclusion The patient experienced significant reduction in symptoms. Additionally, the medical doctor concluded that the reduction in symptoms was significant enough to discontinue the medication. There may be a possible connection that correction of cervical kyphosis in patients with ADHD may produce a desirable clinical outcome.

The sagittal alignment of the cervical spine in adolescent idiopathic scoliosis.

To assess the sagittal orientation of the cervical and thoracolumbar spine, 38 adolescents with idiopathic scoliosis were studied. The C7 plumb line and Cobb angles from C2-6, T1-12, and L1-S1 were measured on preoperative films. Lateral radiographs with > 1-year follow-up after surgical correction were available for the same measurements in 28 patients. The preoperative curve from C2-6 was 6 +/- 11 degrees of kyphosis. There was a significant correlation between the loss of thoracic kyphosis and the development of cervical kyphosis for the entire group preoperatively (p = 0.009). Postoperatively, cervical kyphosis increased to 11 +/- 9 degrees at 1-year follow-up (p = 0.05). There was no progression of cervical kyphosis in patients with "thoracic hypokyphosis" (kyphosis < 20 degrees). Cervical kyphosis increased in patients with "normal" thoracic kyphosis (20-40 degrees) and in patients with hyperkyphosis (kyphosis > 40 degrees) after surgery, despite preservation of thoracolumbar sagittal contour. There were no significant differences between the sagittal contour of patients treated with Cotrel-Dubousset or Harrington instrumentation.