When you look at a model of the spine, there should be couple of things that stand out to you. If you look closely, there are 3 different sections of the spine. There is the cervical portion (neck), the thoracic portion (mid-back), and the Lumbar portion (Lower back). You should also notice that the spine is not perfectly straight. There are slight curves in the back. When you look at the spine from the side it should resemble an “S” shape. These slight curves help evenly distribute your body’s weight. In the Cervical portion of the spine there is a slight lordotic curve. In the Thoracic portion of the spine there is a slight kyphotic curve and in the lumbar spine you will see another slight lordotic curve. As a result of age, inflammation, degeneration, and genetics, these curves can become more kyphotic in the cervical spine. In fact, complex cervical spinal deformity mostly occurs in the sagittal plane and mostly present as kyphotic deformities. This means that that natural lordotic curve is becoming straighter (kyphotic). Notice the MRI on the top, has a slighter lordotic curve, while the x-ray on the bottom has become straighter.
Secondary deformities can occur if kyphotic curves are not corrected.
There are several causes for neck pain and deformity. To start with, one of the issues that contributes to a kyphotic cervical spine is degenerative disc disease. This can lead to destabilization of the spine, narrowing of the foramen where the exiting nerve roots become compressed. Another cause can be congenital in nature. Meaning, that there is some type of defect in the spine from birth. Some people are born with narrowing of the spinal canal and may be predisposed to other neurological issues. Injury can also cause the cervical spine to fall into kyphosis. Compression Fractures and ligament damage can cause the head to fall forward and over time, if left untreated, can cause secondary deformity. The most common cause of cervical spine kyphosis is iatrogenic spinal deformity. Iatrogenic spinal deformity means that there is a deformity caused by previous treatment or surgery. For example, if you have had previous spinal fusion, then those segments are no longer able to move. This changes the way that the spine carries your body weight.
All of these different causes can result in similar symptoms:
- Neck Pain
- Muscle pain in the shoulders, upper, and lower back
- Weakness in the arms or legs
- Loss of grip strength
- Difficulty walking
- In extreme cases: Paralysis
Treatment options are dependent on how effected the nerves are. If there is direct compression to the spinal cord or the exiting nerve roots, then there may be cause for surgery. Conservative treatments may include physical therapy and a possibly wearing a neck brace. It is very important that as a patient you exhaust all conservative treatment. Cervical spinal surgery for complex deformity carries a high risk. Surgical treatment will likely include fusion. The fusion will be facilitated by either a plate or rod to give the neck support and correct the kyphotic curve.