Evaluation and Treatment of Cervical Deformity
Cervical deformity is defined as the loss of normal physiologic alignment of the cervical spine, which can range from asymptomatic to symptoms of pain, neurological deficit, functional limitations, or cosmetic deformity. Cervical deformity is most often iatrogenic in etiology, commonly caused by postlaminectomy kyphosis and loss of the posterior tension band. There are a number of radiographic measures to assess degree of cervical deformity including the cervical sagittal vertical axis, chin-brow vertical angle, T1 slope minus cervical lordosis, and cervicothoracic pelvic angle, among others. Despite multiple investigations to assess the extent of cervical deformity and stratify patients into different categories of disease, consensus has not been achieved on the ideal way to evaluate or stratify patients with cervical deformity. Indications for surgical treatment include failure of conservative therapy for pain control, neurological deficit, functional limitations, cosmetic considerations, instability, or progression of deformity. Surgical treatment can be performed via anterior, posterior, or combined approaches based on the flexibility of the deformity, degree of kyphosis, or spinal cord compression, among other factors. Cervical deformity correction is associated with a relatively high risk of complications, although in well-selected patients, significant improvements in quality of life are achievable.
