An algorithmic strategy for selecting a surgical approach in cervical deformity correction

Abstract

<jats:p>Adult degenerative cervical kyphosis is a debilitating disease that often requires complex surgical management. Young spine surgeons, residents, and fellows are often confused as to which surgical approach to choose due to lack of experience, absence of a systematic method of surgical management, and today's plethora of information regarding surgical techniques. Although surgeons may be able to perform anterior, posterior, or combined (360°) approaches to the cervical spine, many struggle to rationally choose an appropriate approach for deformity correction. The authors introduce an algorithm based on morphology and pathology of adult cervical kyphosis to help the surgeon select the appropriate approach when performing cervical deformity surgery. Cervical deformities are categorized into 5 different prevalent morphological types encountered in clinical settings. A surgical approach tailored to each category/type of deformity is then discussed, with a concrete case illustration provided for each. Preoperative assessment of kyphosis, determination of the goal for surgery, and the complications associated with cervical deformity correction are also summarized. This article's goal is to assist with understanding the big picture for surgical management in cervical spinal deformity.</jats:p>

Surgical Impact on Global Sagittal Alignment and Health-Related Quality of Life Following Cervical Kyphosis Correction Surgery: Systematic Review

“…26 Not a few factors are considered to determine which of the approach is needed, including the location of compressive pathology, type, flexibility and location of the deformity. 27,28 There has been no clear goal of CL to be achieved in cervical deformity correction surgery. Similar to C7 SVA which is traditionally used to measure sagittal alignment of the thoracolumbar deformity, C2-7 SVA is acceptable in cervical deformity correction.…”

Prospective Multicenter Assessment of Early Complication Rates Associated With Adult Cervical Deformity Surgery in 78 Patients

“…assessment of operative complication rates, and rigorous study of clinical outcomes after treatment. [8][9][10][11][12][13][14][15] Smith et al 16 recently reported substantial variability in the surgical planning for treatment of adult cervical deformities among a group of experienced spine surgeons from across North America. As a first step toward more structured study of ACD, Ames et al 17 recently proposed a standardized and easily reproducible classification system to assess cervical deformity within the framework of global spinopelvic alignment and clinically relevant parameters.…”

Postoperative Cervical Deformity in 215 Thoracolumbar Patients With Adult Spinal Deformity

“…10 Traditionally, the presence of any cervical kyphosis has been considered abnormal. However, this defi nition does not necessarily catch all subjects with CD.…”