Cervicothoracic Kyphosis (Dropped Head Deformity) Surgery Complication

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


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.


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


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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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