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Surgical Treatment of Fixed Cervical Kyphosis With Myelopathy

O’Shaughnessy, Brian A. MD; Liu, John C. MD; Hsieh, Patrick C. MD; Koski, Tyler R. MD; Ganju, Aruna MD; Ondra, Stephen L. MD

doi: 10.1097/BRS.0b013e3181695082
Cervical Spine

Study Design. A retrospective clinical study.

Objective. To investigate clinical and radiographic outcomes following the surgical treatment of fixed cervical kyphosis with myelopathy.

Summary of Background Data. To our knowledge, a study specifically addressing the surgical treatment of fixed cervical sagittal deformity has never before been published.

Methods. Sixteen patients treated surgically for fixed cervical kyphosis and myelopathy were followed for a mean of 4.5 years (range, 25–112 months). The study group consisted of 9 males and 7 females, with an average age of 52 years (range, 31–78 years). The principal etiologies of cervical deformity were prior laminectomy (63%), advanced spondylosis (19%), infection (6%), neuromuscular disease (6%), and metabolic disease (renal osteodystrophy) (6%). All patients were clinically evaluated by the Nurick classification and Odom criteria both before surgery and at the time of most recent follow-up. Radiographic analysis was performed using thin-cut CT scans, dynamic radiographs, and 14 × 36-inch scoliosis films.

Results. The mean preoperative cervical Cobb angle as measured from the C2–C7 was +38° and improved to −10° at final follow-up, yielding an average correction of 48°. The mean number of anterior and posterior segments fused was 4.8 (range, 2–6) and 7.2 (range, 3–14), respectively. The mean Nurick score improved from 2.4 before surgery to 1.5 at the time of follow-up. According to Odom criteria, outcomes were as follows: excellent (38%), good (50%), fair (6%), and poor (6%). At the time of most recent follow-up, solid bony arthrodesis and maintenance of correction occurred in all patients; however, revision was required in one patient.

Conclusion. The treatment of fixed cervical kyphosis with myelopathy using circumferential spinal osteotomies and instrumented reconstruction is technically demanding; however, restoration and maintenance of a neutral or lordotic cervical profile and excellent clinical outcomes are achievable.

The authors report the clinical and radiographic outcomes associated with the surgical treatment of fixed cervical kyphosis with myelopathy. All patients underwent circumferential osteotomies and instrumented spinal fusion. A neutral or lordotic cervical contour was achieved in all patients and most subjects had an excellent or good clinical outcome.

From the Department of Neurological Surgery, Feinberg School of Medicine, McGaw Medical Center, Northwestern University, Chicago, Illinois.

Acknowledgment date: May 19, 2007. First revision date: September 16, 2007. Second revision date: October 6, 2007. Acceptance date: October 8, 2007.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Stephen L. Ondra, MD, Professor of Neurological Surgery, Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, 676 St Clair Street, 22-10, Chicago, IL 60611; E-mail: sondra@nmff.org

© 2008 Lippincott Williams & Wilkins, Inc.