Cervical Deformities

What are Cervical Deformities?

The spine is made up of 33 small bones called vertebrae and is known as the spinal column or vertebral column. It can be divided into 5 parts: cervical, thoracic, lumbar, sacral, and coccyx region. The cervical spine is comprised of the first 7 vertebrae, which supports the neck and the head. Any abnormality in the alignment, shape, or formation of the cervical vertebral column is called cervical spine deformities.

Deformities of the cervical spine usually results in an abnormal posture of the head in comparison with the chest and shoulders. Cervical deformity can also result in breathing and swallowing difficulty and can severely disturb a person’s capacity to do normal tasks such as eating, drinking, reading, or driving.

Conditions Associated with Cervical Deformities

Some of the common conditions associated with cervical spine deformities include:

• Cervical myelopathy: A condition characterized by damage of the spinal cord due to stenosis or degeneration.
• Cervical spinal stenosis: A condition characterized by narrowing of the spinal canal around the spinal cord.
• Cervical spondylosis: A condition that causes deterioration of the vertebrae, disks, and ligaments in the neck or cervical spine.
• Cervical radiculopathy: A condition commonly called a “pinched nerve” that occurs when a nerve in the neck is irritated or compressed where it branches away from the spinal cord.
• Cervical herniated disk: A condition where disks between the vertebrae rupture, protrude, or bulge out
• Cervical degenerative disk disease: A common cause of neck pain and stiffness that develops when one or more disks in the cervical spine breaks down due to wear and tear.

Causes of Cervical Deformities

The most common causes of cervical spine deformities include:

• Post-traumatic – resulting from injury or trauma
• Inflammatory – resulting from certain inflammatory conditions such as ankylosing spondylitis
• Degenerative – progressive collapse of the cervical vertebrae and/or intervertebral disks

Symptoms of Cervical Deformities

Symptoms of cervical spine deformity start gradually and worsen over time and vary depending on the location and the nerves affected, including:

• Neck pain
• Weakness in the arm, hand, foot or leg
• Numbness or tingling in the arm, hand, foot or leg
• Difficulty with balance and walking
• Bladder or bowel dysfunction (in severe cases)
• Dysphagia (difficulty swallowing)
• Dyspnoea (shortness of breath)

Diagnosis of Cervical Deformities

To arrive at an accurate diagnosis, a detailed review of your medical history coupled with a physical and neurological examination is conducted. Neurological examination helps identify any signs of neurological injury and involves evaluation of reflexes and muscle weakness. For a detailed view of the soft tissue structures as well as to confirm the diagnosis, imaging studies may be required, including:

• CT scan that shows the shape, size and contents of the spinal canal and the surrounding structures
• EMG and nerve conduction studies that measure the electrical impulses along the nerves and muscle tissue
• MRI that produces a detailed view of the body structures and can show nerve roots, spinal cord, tumours, degeneration, and enlargement
• Myelogram, a special type of X-ray or CT scan in which a dye is injected prior to imaging that shows pressure on the spinal cord or nerves due to bone spurs, tumours, or herniated disks
• X-ray films that can show the structures of the vertebrae and outline of the joints

Treatment for Cervical Deformities

Nonsurgical or conservative treatment is always the first approach to treat cervical spine deformities and includes measure such as activity modification, pain medication, non-steroidal anti-inflammatory drugs, muscle relaxants, physical therapy, spinal injections, and use of soft collars.

If conservative treatment fails to alleviate symptoms of cervical spine deformities, surgical treatment is employed and includes:

• Cervical laminectomy: This procedure is undertaken to alleviate pressure on the spinal cord or the nerve roots. The spinal cord is covered and protected by laminae, which are bony plates on the back side of the vertebrae. Pressure on the spinal cord and nerves are reduced by removing the laminae. Also, during this procedure, sections of bone spurs and herniated disk can be removed through the opening in the vertebrae.
• Cervical laminoplasty: This procedure is used to assist people with spinal stenosis by making more space for the spinal cord within the spinal canal. During this procedure, the spine is exposed by making an incision on the back of the neck and the vertebral laminae is reconstructed to enlarge the spinal canal creating more room.
• Anterior cervical diskectomy: This is regarded as the most common surgical procedure performed to mitigate neck pain caused by a nerve-pinching herniated disk. During this procedure, the spine is exposed by making an incision in the front of the neck right next to the windpipe. Through that incision, bone spurs or herniated disks that may be causing pain are removed. Then, a piece of bone (either your own or a bone graft from a donor) or other material is used to refill the space left between the vertebrae, fusing the adjacent vertebrae together.
• Cervical spinal fusion: During this procedure, two vertebrae that are rubbing against each other are fused together as the disk between them has worn out or herniated. A metal implant or bone graft is used to fuse the vertebrae, which ultimately grows together into one bone.
• Posterior microdiskectomy: This approach is employed to treat a large soft disk herniation located on the side of the spinal cord and is performed by making a vertical incision in the posterior of your neck. A high-speed burr is utilized to detach some of the facet joint to identify the nerve root under it. The nerve root is gently moved aside to make room for the surgeon to remove the disk herniation.