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

Surgical Treatment

One of the keys to surgical success is a thorough preoperative planning. Ideally, the CS should be made perpendicular to the clavicles in the coronal plane. Considerations in the sagittal plane should include flexibility and assessment of occiput-C2 motion. We prefer to align the posterior vertebral line of C2 as close to the anterior vertebral line of C7 as possible. This results in a balanced cervical posture, assuming the TLS is already well aligned. In the setting of a spine without mobile cervical segments, we attempt correction to a minimally flexed (15° to 20°) cervical alignment to allow the patient to be able to visualize the ground in front of him/her.

Approaches to deformity correction can be broadly categorized into anterior, posterior, and combined. The strategy for selecting a particular approach is often not straightforward. Hann et al[31] attempted to delineate an algorithm for surgical approach selection based on fixed versus passively correctable deformities. A detailed graphical summary of the article has been provided, delineating possible surgical approach and techniques for addressing various cervical deformities (Figure 7).

Figure 7.

Algorithmic selection of cervical deformity based on flexibility. (Reproduced with permission from Hann S, Chalouhi N, Madineni R, et al: An algorithmic strategy for selecting a surgical approach in cervical deformity correction. Neurosurg Focus 2014;36[5]:E5.)31