The spine has many curves that can be viewed from the side. These spinal curves can absorb some weight from the body. The upper spine (neck) is called the cervical spine, and the lower back is called the lumbar spine that has inward curvature. Technically it is called lordosis or lordotic curvature, where the spine is bent backwards. The upper back, called the thoracic spine, has outward curvature in general.
But kyphosis is an abnormal shape of the spine. It is described as a “C”-shaped curve of the spine. The kyphotic curve looks like a “C” shape when you look from sideways. The kyphosis curve is the opposite of the natural “lordotic” curve in the spine. A lordotic curve develops inward, whereas the kyphotic curve is opening face outwards. If these curves become more significant, they create many health issues – the bigger the curve, the more dangerous the problem. Kyphosis is caused due to various conditions that can lead to various health problems within the spine along with unusual appearance.
Causes Of Cervical Kyphosis
Several causes can lead to cervical kyphosis, and it can develop both in children and adults. Poor posture of the neck while awake or while sleeping is the reason for cervical problems. Poor posture while working on your computer, functional conditions, or repetitive movements, are also a reason. However, several medical conditions can also develop cervical kyphosis, such as:
Degenerative Disc Disease: Degenerative disc disease is one of the leading causes of Cervical problems in adults. The degeneration process of the intervertebral discs leads to many spine problems. In older adults, the disc may collapse due to the wear and tear of ageing on the discs between vertebrae. As the discs collapse and become thinner, the head tilts forward due to its weight and pushes the neck forward, resulting in a curve. This is not a sudden process; it progresses for years. The curve slowly increases with time and ends up with kyphosis, often termed as Cervical kyphosis.
The ageing process is essentially a kyphotic process. Treatment decisions for this in the presence of myelopathy is very important as this changes the approach and the type of surgery.
Congenital Defects: Usually, it is seen in children and occurs at the time of birth itself, also known as a birth defect or congenital disability. Cervical kyphosis due to congenital disability is associated with other complications, such as urinary or kidney defects.
Tuberculosis: Kyphosis due to cervical Tuberculosis(TB) can be seen at any age. Spinal deformity and quadriplegia(paraplegia) – paralysis of all four limbs are the infrequent conditions associated with tuberculosis (TB) of the spine. TB of the dorsal spine mostly produces kyphosis, while the cervical and lumbar spine results in a reversal of lordosis, followed by kyphosis.
Cervical Kyphosis Due To Trauma: Trauma can also result in cervical kyphosis. The ligaments of the spine fracture and curve forward caused due to trauma as a result of a car accident, a fall, or a sports injury. In severe cases, people experience neurological problems narrowing the spinal canal called spinal stenosis.
Iatrogenic Disorder: It is an unintended outcome of a medical procedure, and it is not uncommon. Laminectomy is the most common procedure for this disorder. Laminectomy creates space for the spinal cord but sometimes destabilizes causing cervical kyphosis. The iatrogenic disorder can also arise from an unsuccessful cervical spine fusion.
Cervical Kyphosis Due To Ankylosing Spondylitis: Ankylosing spondylitis(AS) can cause severe cervical kyphosis. If the kyphosis is due to ankylosing spondylitis, then the problem area extends over the spine, where the cervical and thoracic spine meet. Ankylosing spondylitis (AS) can cause calcification of the discs between the vertebrae and may fuse the entire spine. This spinal fusion can sometimes result in forwarding curvature of the spine, called kyphosis, creating a forward-stooped posture.
Chin On Chest Cervical Kyphosis: Chin on chest syndrome is a type of hyperkyphosis. It is a spinal deformity where the vertebrae in the neck curve forward, creating a hump. Moreover, the curvature can exceed >50 degrees causing structural damage to the spine. As the neck muscles get weaker, it results in flexion deformity (unable to straighten the neck).
Some other less common causes that can cause cervical kyphosis include – spinal tumours and other infections in the spine. Radiation therapy in children for cancer involving the neck may affect the development of cervical vertebrae in children. It may also result in cervical kyphosis years after cancer treatment.
Symptoms of Cervical Kyphosis
Cervical kyphosis symptoms can range from mild neck pain to a severe deformity, which may lead to paralysis if left untreated.
- Severe headaches
- Weakness in the arms or legs(muscle weakness)
- Pain in the neck and the lower extremities includes fingers and toes
- coordination problems
- Difficulty in walking
- Spine deformity
- Loss of bladder and bowel control
However, everyone with a cervical kyphosis may not experience the same symptoms. Paralysis, loss of bladder control, and bowel control problems are seen only in extreme cases, especially when the condition is left untreated.
Treatment For Cervical Kyphosis
Cervical kyphosis can be treated either non-surgically or surgically. Cervical kyphosis treatment is very much dependent on the pressure on the spinal cord. If the condition pressures the spinal cord, then surgery is done immediately.
Non-surgical Treatment For Cervical Kyphosis
Physical therapies, a neck brace, and pain medications are standard treatment options suggested in case of mild cervical problems. Physical therapy by experienced physicians can help in the reduction of pain, improves flexibility and posture. Applying ice packs, heating pads, and maintaining proper neck posture while sleeping and working can also help treat cervical kyphosis.
If the spinal deformity is not getting worse, and if there no sign of neurological problems, surgery may not be recommended and treated through conventional options. However, even cervical deformity is fixed but accompanied by neurological problems due to pressure on the spinal cord; then, surgery is necessary to correct the deformity.
Treatment for cervical kyphosis is based on whether there is excessive pressure on the spinal cord or not. If your spinal cord is under pressure, then a surgeon recommends surgery immediately.
Surgical Treatment For Cervical Kyphosis
Cervical surgery is not simply recommended because the deformity looks bad. After all, it is a complicated procedure. Surgical correction of kyphosis is suggested based on the rate of deformity progression, severity, and the pain it causes.
In some cases, the kyphotic curve of the spinal cord takes on a frontal position, which causes over-stretching of the kyphotic curve/deformity. This creates enormous pressure on the spinal cord leading to a condition called cervical myelopathy – a diseased spinal cord. This condition is treated by alleviating the pressure through decompression surgery with spinal fusion. It helps to stabilize the spine by removing damaged discs. Cervical kyphosis with myelopathy almost always needs surgery.
In the case of severe kyphosis, surgery is inevitable, and many surgical methods have evolved over time. Spinal fusion combined with “segmental instrumentation” is one of the common surgical procedures. The procedure involves inserting a metal plate or rod to hold the spine in proper alignment.
Surgical correction of cervical kyphosis is one of the most challenging procedures. The operation involves relieving pressure on the spinal cord from the front of the spine called an anterior cervical discectomy, and operation from the back to fuse the spine posterior cervical fusion to prevent the kyphosis from recurring.
If the cervical kyphosis is due to ankylosing spondylitis, then surgery includes performing an “osteotomy.” During an osteotomy, the spinal column is straightened through anterior cervical surgery. Chin on chest deformity is rare, and addressing this type of deformity can be complicated. It needs to be treated with an osteotomy at the base of the neck.
However, surgical techniques and safety have improved a lot over the past decades. Spine Surgeons have become experienced and skilled enough to handle most of the problems associated with the spine. Dr Surya Prakash Voleti is one of the best spine surgeons in Hyderabad, who has more than two decades of experience treating various spine problems. If you or your family members are suffering from any back problems, get a consultation before it is too late.