The typical treatment for congenital kyphosis is surgery. Early surgical intervention usually produces the best results and can prevent progression of the curve. The type of surgical procedure will depend on the nature of the abnormality. Conservative treatments do not have much success at correcting this type of kyphosis. When surgery is not done, it is critical that the condition is observed and that close medical follow-up is done, including X-rays and MRI scans. This is to make sure the kyphosis isn’t worsening to the point it causes more serious problems.
Treatment for cervical kyphosis depends largely on whether there is pressure on the spinal cord. If there is, surgery may be suggested. If the cervical kyphosis is primarily causing pain and concern about your appearance, then the doctor may consider trying to control the pain and deformity with a neck brace for a short period of time, pain medications, and a physical therapy program.
Your doctor may have you work with a physical therapist. A well-rounded rehabilitation program assists in calming pain and inflammation, improving your mobility and strength, and helping you do your daily activities with greater ease and ability.
Exercise has not proven helpful for changing the kyphotic curve in the neck. However, it can be helpful in providing pain relief. Therapy sessions may be scheduled two to three times each week for up to six weeks.
The goals of physical therapy are to help you
- learn correct posture and body movements to counteract the effects of kyphosis
- maintain appropriate activity levels
- maximize your neck range of motion and strength
- learn ways to manage your condition
If the kyphosis is flexible, the decision to go ahead with surgery will be based on the progression of the curve and the amount of pain it causes. If the curve and pain are minor, surgery may not be recommended-even if the deformity looks unattractive. If the deformity is severe and the pain is chronic, surgery may be a good option.
Surgery is usually not recommended when the deformity is fixed (inflexible but not worsening) and if there are no problems with the nerves or spinal cord. If a fixed deformity is accompanied by neurological problems from pressure on the spinal cord, the need for surgery is greater. Surgical correction is the most difficult type of treatment for cervical kyphosis.
Surgery to treat cervical kyphosis usually involves spinal fusion combined with segmental instrumentation. This means that some type of metal (titanium) plate or rod is used to hold the spine in the proper alignment to straighten it. Surgery may require two procedures done during the same operation. First, surgery to the front of the spine is done to relieve the pressure on the spinal cord. The second procedure is done through the back to fuse the spine and prevent the kyphosis from returning.
If the kyphosis is due to ankylosing spondylitis (AS), the connection between the cervical and thoracic spine is the problem area. This type of cervical kyphosis is usually a fixed deformity. In AS the discs between each vertebra of the entire spine calcify and fuse the bones of the spine together. If there is a cervical kyphosis after AS fuses the spine, the surgeon may need to do an osteotomy of the fused spine. “Osteo” means bone, and “otomy” means cut. This procedure involves cutting the front of the spinal column so the surgeon can straighten the spine. The spinal cord is not cut-only the bones of the vertebrae in the front of the spinal column.