title: Cervical kyphosis trapezius sign: a new sign for an old pathology.
abstract: OBJECTIVE
  Cervical kyphosis may develop in patients with a variety of conditions. It commonly occurs following cervical spine surgery. To our knowledge, no specific physical examination finding in patients with cervical kyphosis has been previously described. It has been our observation that patients with symptomatic cervical kyphosis often have prominent, taut, and painful trapezius muscles. We coined the term cervical kyphosis trapezius sign (CKTS). This article describes the use of this sign as a clinical marker for management and outcome assessment.
  
  
  METHODS
  We retrospectively analyzed the files of symptomatic cervical kyphosis patients who have been treated by the senior author (E.C.B.) and have been photographed. We also quantified the reliability and accuracy of CKTS by presenting clinical photographs to health care providers.
  
  
  RESULTS
  Fifteen patients fulfilled the inclusion criteria. All patients had preoperative photographs of their neck that showed the CKTS. Six patients were treated conservatively and nine underwent surgical correction. Mean follow-up for surgical cases was 14.7 months. Postoperative neck photographs demonstrated a normalization of the prominent and painful trapezius muscle in each case. When examining the reliability of CKTS, we found overall interobserver reliability to be 0.671 with an intraobserver reliability of 0.678.
  
  
  CONCLUSIONS
  CKTS is a simple, objective, and potentially clinically useful indicator of cervical kyphotic deformity. Resolution of CKTS postoperatively had an associated high rate of pain relief. Therefore, the presence of CKTS in a symptomatic patient with cervical kyphosis is a potential indicator for surgical correction of the deformity.
authors.affiliation: Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Ran
authors.initials: R
authors.lastname: Harel
authors.forename: William F
authors.initials: WF
authors.lastname: Lavelle
authors.forename: Ron I
authors.initials: RI
authors.lastname: Riesenburger
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Demers
authors.forename: Edward C
authors.initials: EC
authors.lastname: Benzel
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007738:Kyphosis / Q000473:pathology*; D008297:Male; D008505:Medical Staff, Hospital / Q000706:statistics & numerical data; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000473:pathology*; D019547:Neck Pain / Q000473:pathology; D009462:Neurology / Q000592:standards* / Q000706:statistics & numerical data; D009722:Nurse Practitioners / Q000706:statistics & numerical data; D015588:Observer Variation; D010823:Physician Assistants / Q000706:statistics & numerical data; D010820:Physicians / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000473:pathology*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013122:Spinal Diseases / Q000601:surgery*