Surgical Management of Cervical Kyphosis. A Long Term Follow-Up Study

Materials and Methods: Between 1985 and 2000, twenty-three patients were treated surgically for symptomatic cervical kyphosis. Follow-up averaged 6.9 years (range, 2 to 17 years). Etiology included prior multilevel cervical laminectomy (16), previous cervical trauma (2), post-radiotherapy myopathy (3), and cervical spondylosis (2). The mean preoperative kyphosis was 45 degrees (range, 25 to 85 degrees). Ten patients complained of visual field disturbances, twenty-two with neck pain, and four noted difficulty with swallowing. Twenty patients demonstrated preoperative radiculopathy and/or myelopathy.

Results: Eleven patients were treated with anterior procedures alone, nine with combined anterior and posterior procedures, and three with posterior procedures. Correction of sagittal alignment was accomplished through anterior corpectomy (16), anterior and posterior cervical osteotomy (4), and posterior column shortening (3). Autogenous iliac crest onlay graft was used for posterior arthrodesis, and iliac crest or fibular strut autograft was used for all anterior arthrodesis. Significant neurological improvement (20/20) and correction of deformity (22/23) was noted in long-term follow-up. Complications included graft dislodgement in three patients and strut graft collapse leading to clinically significant loss of correction in one patient.

Conclusions: In patients with cervical kyphosis, anterior corpectomy and/or posterior cervical osteotomy through the kyphotic segments provides adequate decompression of neural elements and restoration of sagittal alignment. Anterior or posterior arthrodesis can be successfully achieved through a variety of surgical techniques. Patients with a diagnosis of post-radiotherapy kyphosis represent a particular challenge and should be considered for combined anterior and posterior procedures. The majority of complications arise from graft dislodgement or graft failure in patients with poor bone quality.