Anterior correction of cervical kyphotic deformity: effects on myelopathy, neck pain, and sagittal alignment.
OBJECTIVE
Cervical myelopathy may develop as a result of spinal cord compression with or without deformity. The effect of persistent kyphotic deformity on the ability of the cervical cord to recover following decompressive surgery is not known.


METHODS
Between 1997 and 2000, a total of 28 patients with progressive myelopathy and kyphotic deformity underwent anterior decompression, deformity correction (0-4 degrees of lordosis), and fusion with anterior plating. Patients received clinical and radiological follow-up care, with independent analysis. Variables assessed included patient characteristics, severity of preoperative myelopathy, neck pain, and cervical sagittal alignment. Twenty-six patients (93%) underwent follow-up review for a minimum of 18 months. Two patients died: one died in the perioperative period and was excluded from further analysis, and in the other only 3 months of follow-up data could be obtained. Local deformity was corrected to neutral or lordosis in 24 cases (89%), and the overall cervical curve was corrected to neutral or lordosis in 20 cases (74%). There was a significant improvement in myelopathy scores in those patients in whom the target (0 to 4 degrees of lordosis) local angle was achieved (p = 0.04). There was a variable change in overall cervical sagittal alignment following local correction. Improvement in myelopathy was unrelated to patient age, previous surgery, or number of segments fused. Improvement in pain score was not related to correction of kyphotic angle.


CONCLUSIONS
The correction of sagittal alignment may promote recovery in spinal cord function in patients with kyphotic deformity.
Ferch
Richard D
RD
Department of Neurosurgery, John Hunter Hospital and University of Newcastle, Newcastle, Australia. rferch@bigpond.com
Shad
Amjad
A
Cadoux-Hudson
Tom A D
TA
Teddy
Peter J
PJ
D000203:Activities of Daily Living / Q000145:classification; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007738:Kyphosis / Q000175:diagnosis / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000175:diagnosis / Q000601:surgery*; D009460:Neurologic Examination; D011183:Postoperative Complications / Q000175:diagnosis*; D013117:Spinal Cord Compression / Q000175:diagnosis / Q000601:surgery*; D013123:Spinal Fusion; D013128:Spinal Osteophytosis / Q000175:diagnosis / Q000601:surgery*