Cervical Spine Deformity

Indications, Considerations, and Surgical Outcomes

Samuel K. Cho, MD; Scott Safir, MD; Joseph M. Lombardi, MD; Jun S. Kim, MD


J Am Acad Orthop Surg. 2019;27(12):e555-e567. 

In This Article

Preoperative Evaluation

Patients with cervical deformity whether AS or iatrogenic often have other medical comorbidities that increase the risk of morbidity and mortality. A thorough preoperative medical evaluation should be performed and the patient optimized before surgery. Nutrition and smoking status should be assessed in every case. Osteotomies can lead to substantial blood loss, and thus, preoperative measures should be taken to have blood prepared.

Radiographic evaluation should include long-standing radiographs to assess GSA and coronal alignment. A preoperative CT provides information on existing implants, fusion masses, and osseous landmarks for planned instrumentation. MRI should also be part of the workup in the setting of an abnormal preoperative neurologic examination, previous decompression surgery, or congenital anomalies.

Surgical management of cervical deformity requires meticulous preoperative planning to determine the approach and the degree of correction needed. Digital imaging software can allow surgeons to plan their osteotomies and provide insight into the postoperative alignment that can be attained.[30]