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Surgical treatment of fixed cervical kyphosis with myelopathy.

O'Shaughnessy BA, Liu JC, Hsieh PC, Koski TR, Ganju A, Ondra SL

Department of Neurological Surgery, Feinberg School of Medicine, McGaw Medical Center, Northwestern University, Chicago, Illinois 60611, USA.

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 x 36-inch scoliosis films. RESULTS: The mean preoperative cervical Cobb angle as measured from the C2-C7 was +38 degrees and improved to -10 degrees at final follow-up, yielding an average correction of 48 degrees . 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.

Published 1 April 2008 in Spine, 33(7): 771-8.
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