Correction of Chronic Progressive Cervical Deformity: An Assessment of 74 Consecutive Cases

Progressive kyphotic deformity of the cervical spine is a common late sequelae of congenital anomaly, remote trauma, surgical iatrogenesis and degenerative disease. Seventy–four consecutive operated cases of subaxial kyphosis and collapse at three to six vertebral levels treated over a five year period (1993–1998) are presented. All patients presented with axial neck pain and varying degrees of myeloradiculapathy. Recent trauma and neoplasm were excluded. Twelve patients had degenerative or iatrogenic chin on chest deformity due to degenerative disease or following prior surgical intervention. Mean preop kyphosis was minus 35 degrees. Mean postop kyphosis was minus 2 degrees for an average change (correction) of 32.7 degrees.

Five had kyphosis following remote trauma. Two adults had scoliotic kyphosis from congenital anomalies. Mean preop kyphosis was minus 7 degrees. These 7 patients underwent dorsal–ventral procedures. Mean postop angulation was plus 8 degrees; mean change of plus 14 degrees.

Sixty seven patients had progressive kyphotic deformity following prior surgical intervention(52) or from degenerative diseased 5). Average preop kyphosis was minus 7 degrees; postop angulation was plus 8 degrees for a mean correction of 15 degrees.

Mean follow up was 3.6 years, 4 lost after 9 months. Mortality was zero. Morbidity included C5 root paresis (2), iatrogenic root injury (1), recurrent laryngeal nerve palsy (1), wound infection (1), and reconstruction failures requiring revision (5). No patient suffered worsening myelopathy. Ninety–two percent had lasting improvement of kyphosis. We present our philosophy and surgical techniques which have helped to maximize patient outcome.