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Cervicothoracic Kyphosis (Dropped Head Deformity) Surgery Complication

  • Subaraman Ramchandran
  • Themistocles S. Protopsaltis
  • Christopher P. AmesEmail author
Chapter

Abstract

Cervicothoracic kyphosis is a complex group of disorders frequently associated with chin-on-chest deformities which can significantly affect the patient’s ability to maintain horizontal gaze, produce pain, and cause severe functional disability. Accompanying these disorders frequently are neuromuscular conditions like myopathies and chronic inflammatory arthropathies like ankylosing spondylitis and rheumatoid arthritis, creating further challenges in managing these deformities. Unlike the thoracolumbar deformities, substantial efforts have not been made to characterize clinical presentations, apply standardized classification systems, define optimal treatment approaches, describe operative complication rates, and present structured clinical outcomes for adult cervical deformities. Health professionals providing nonoperative and surgical care for these patients are left to make important treatment decisions based on a combination of personal experience, anecdotal experience of colleagues and experts, and relatively small, often single-surgeon or single-center, retrospective case reports or case series in the literature. This has posed a great challenge in counseling such patients regarding the prognosis and explaining to them the possible complications following surgery for cervical and cervicothoracic deformities. Based on the approach, surgical invasiveness, performance of osteotomies, and surgeon expertise, early postoperative complications have ranged from 20 to 80% including medical complications, dysphagia, postoperative C5 nerve palsy, surgical site infections, and early instrumentation failure. Mid- to long-term complications include pseudoarthrosis, hardware failure, and adjacent segment and junctional pathologies. We present a case of ankylosing spondylitis with cervicothoracic kyphosis operated for deformity correction developing subsequent distal junctional kyphosis.

Keywords

Chin-on-chest deformities Cervicothoracic kyphosis Complications Distal junctional kyphosis 

References

  1. 1.
    Shamji MF, Ames CP, Smith JS, Rhee JM, Chapman JR, Fehlings MG. Myelopathy and spinal deformity: relevance of spinal alignment in planning surgical intervention for degenerative cervical myelopathy. Spine. 2013;38(22 Suppl 1):S147–8.CrossRefPubMedGoogle Scholar
  2. 2.
    Scheer JK, Tang JA, Smith JS, et al. Cervical spine alignment, sagittal deformity, and clinical implications: a review. J Neurosurg Spine. 2013;19(2):141–59.CrossRefPubMedGoogle Scholar
  3. 3.
    Smith JS, Lafage V, Ryan DJ, Shaffrey CI, Schwab FJ, Patel AA, et al. Association of myelopathy scores with cervical sagittal balance and normalized spinal cord volume: analysis of 56 preoperative cases from the AOSpine North America myelopathy study. Spine. 2013;38(22 Suppl 1):S161–70.CrossRefPubMedGoogle Scholar
  4. 4.
    Uchida K, Nakajima H, Sato R, et al. Cervical spondylotic myelopathy associated with kyphosis or sagittal sigmoid alignment: outcome after anterior or posterior decompression. J Neurosurg Spine. 2009;11(5):521–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Doherty KM, van de Warrenburg BP, Peralta MC, et al. Postural deformities in Parkinson’s disease. Lancet Neurol. 2011;10(6):538–49.CrossRefPubMedGoogle Scholar
  6. 6.
    Fugimoto K. Dropped head in Parkinson’s disease. J Neurol. 2006;253(suppl 7):VII21–6.Google Scholar
  7. 7.
    Ashour R, Jankovic J. Joint and skeletal deformities in Parkinson’s disease, multiple system atrophy and progressive supranuclear palsy. Mov Disord. 2006;21(11):1856–63.CrossRefPubMedGoogle Scholar
  8. 8.
    Hoffman D, Gutmann L. The dropped head syndrome with chronic inflammatory demyelinating polyneuropathy. Muscle Nerve. 1994;17:808–10.CrossRefPubMedGoogle Scholar
  9. 9.
    Moore RE, Dormans JP, Drummond DS, Shore EM, Kaplan FS, Auerbach JD. Chin-on-chest deformity in patients with fibrodysplasia ossificans progressiva. A case series. J Bone Joint Surg Am. 2009;91(6):1497–502.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Albayrak I, Bagcaci S, Salli A, Kucuksen S, Ugurlu H. A rare cause of dysphagia: compression of the esophagus by an anterior cervical osteophyte due to ankylosing spondylitis. Korean J Intern Med. 2013;28(5):614–8.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Bowen RE, Abel MF, Arlet V, et al. Outcome assessment in neuromuscular spinal deformity. J Pediatr Orthop. 2012;32(8):792–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Duckworth AD, Mitchell MJ, Tsirikos AI. Incidence and risk factors for post-operative complications after scoliosis surgery in patients with Duchenne muscular dystrophy: a comparison with other neuromuscular conditions. Bone Joint J. 2014;96-B(7):943–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Asher MA, Lai SM, Burton DC. Subsequent, unplanned spine surgery and life survival of patients operated for neuropathic spine deformity. Spine (Phila Pa 1976). 2012;37(1):E51–9.CrossRefGoogle Scholar
  14. 14.
    Protopsaltis TS, Boniello AJ, Schwab FJ. Management of spinal deformity in adult patients with neuromuscular disease. J Am Acad Orthop Surg. 2016;24:634–44.CrossRefPubMedGoogle Scholar
  15. 15.
    Smith JS, Ramchandran S, Lafage V, International Spine Study Group, et al. Prospective multicenter assessment of early complication rates associated with adult cervical deformity surgery in 78 patients. Neurosurgery. 2016;79(3):378–88.CrossRefPubMedGoogle Scholar
  16. 16.
    Gerling MC, Bohlman HH. Dropped head deformity due to cervical myopathy: surgical treatment outcomes and complications spanning twenty years. Spine (Phila Pa 1976). 2008;33(20):E739–45.CrossRefGoogle Scholar
  17. 17.
    Bydon M, Macki M, Kaloostian P, et al. Incidence and prognostic factors of c5 palsy: a clinical study of 1001 cases and review of the literature. Neurosurgery. 2014;74(6):595–604. discussion 604-605CrossRefPubMedGoogle Scholar
  18. 18.
    Etame AB, Wang AC, Than KD, La Marca F, Park P. Outcomes after surgery for cervical spine deformity: review of the literature. Neurosurg Focus. 2010;28(3):E14.CrossRefPubMedGoogle Scholar
  19. 19.
    Fehlings MG, Smith JS, Kopjar B, et al. Perioperative and delayed complications associated with the surgical treatment of cervical spondylotic myelopathy based on 302 patients from the AOSpine North America cervical spondylotic myelopathy study. J Neurosurg Spine. 2012;16(5):425–32.CrossRefPubMedGoogle Scholar
  20. 20.
    Lubelski D, Derakhshan A, Nowacki AS, et al. Predicting C5 palsy via the use of preoperative anatomic measurements. Spine J. 2014;14:1895–901.CrossRefPubMedGoogle Scholar
  21. 21.
    Singh K, Marquez-Lara A, Nandyala SV, Patel AA, Fineberg SJ. Incidence and risk factors for dysphagia after anterior cervical fusion. Spine. 2013;38:1820–5.CrossRefPubMedGoogle Scholar
  22. 22.
    Daniels AH, Riew KD, Yoo JU, et al. Adverse events associated with anterior cervical spine surgery. J Am Acad Orthop Surg. 2008;16:729–38.CrossRefPubMedGoogle Scholar
  23. 23.
    Tang JA, Scheer JK, Smith JS, et al. The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery. Neurosurg. 2012;71:662–9. discussion 669CrossRefGoogle Scholar
  24. 24.
    Iyer S, Nemani VM, Nguyen J, et al. Impact of cervical sagittal alignment parameters on neck disability. Spine (Phila Pa 1976). 2016;41(5):371–7.CrossRefGoogle Scholar
  25. 25.
    Glattes RC, Bridwell KH, Lenke LG, et al. Proximal junctional kyphosis in adult spinal deformity following long instrumented posterior spinal fusion: incidence, outcomes, and risk factor analysis. Spine (Phila Pa 1976). 2005;30:1643–9.CrossRefGoogle Scholar
  26. 26.
    Yagi M, Akilah KB, Boachie-Adjei O. Incidence, risk factors and classification of proximal junctional kyphosis: surgical outcomes review of adult idiopathic scoliosis. Spine (Phila Pa 1976). 2011;36:E60–8.CrossRefGoogle Scholar
  27. 27.
    Cho SK, Shin JI, Kim YJ. Proximal junctional kyphosis following adult spinal deformity surgery. Eur Spine J. 2014;23(12):2726–36. doi: 10.1007/s00586-014-3531-4.CrossRefPubMedGoogle Scholar
  28. 28.
    Lowe TG, Lenke L, Betz R, Newton P, Clements D, Haher T, Crawford A, Letko L, Wilson LA. Distal junctional kyphosis of adolescent idiopathic thoracic curves following anterior or posterior instrumented fusion: incidence, risk factors, and prevention. Spine (Phila Pa 1976). 2006;31(3):299–302.CrossRefGoogle Scholar
  29. 29.
    Lonner BS, Newton P, Betz R, Scharf C, O’Brien M, Sponseller P, Shufflebarger H. Operative management of Scheuermann’s kyphosis in 78 patients: radiographic outcomes, complications, and technique. Spine (Phila Pa 1976). 2007;32(24):2644–52.CrossRefGoogle Scholar
  30. 30.
    Protopsaltis TS, Ramchandran S, Kim HJ, International Spine Study Group, et al. Analysis of early Distal Junctional Kyphosis (DJK) after cervical deformity correction. Presented at the 51st Annual meeting of the Scoliosis Research Society, Prague, Czech Republic. 2016.Google Scholar
  31. 31.
    Ramchandran S, Smith JS, Ailon T. International spine study group, AOSNA et al. assessment of impact of long cassette standing radiographs on surgical planning of cervical pathology: an international survey of spine surgeons. Neurosurgery. 2016;78(5):717–24.CrossRefPubMedGoogle Scholar
  32. 32.
    Takenaka S, Hosono N, Mukai Y, et al. Significant reduction in the incidence of C5 palsy after cervical laminoplasty using chilled irrigation water. Bone Joint J. 2016;98-B(1):117–24.CrossRefPubMedGoogle Scholar

Copyright information

© The Author(s) 2018

Authors and Affiliations

  • Subaraman Ramchandran
    • 1
  • Themistocles S. Protopsaltis
    • 2
  • Christopher P. Ames
    • 3
    Email author
  1. 1.Department of Orthopedic SurgeryNYU Langone Medical Center’s Hospital for Joint DiseasesNew YorkUSA
  2. 2.Department of Orthopedic SurgeryNYU Langone Medical CenterNew YorkUSA
  3. 3.Department of Neurological SurgeryUniversity of CaliforniaSan FranciscoUSA

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