Unlike lumbar and thoracic curves, cervicothoracic junction (CTJ) kyphosis, a distinctive and complex cause of neck pain and other symptoms, is not normally associated with scoliosis. Instead, CTJ deformity involves a sagittal imbalance, where the spine takes on abnormal curvature front to back rather than side to side.
Treating CTJ deformity can be difficult and likely involves back and neck surgery to reconstruct the spine in order to restore balance and realign the neck and head.
Abnormal Spinal Curves
Kyphosis in the spine is normal in the thoracic region, whereas lordosis is normal in the lumbar and cervical spine, thus creating an s-shaped curve when looking at the spine from the side. Exaggeration of these curves, including hyperlordosis (swayback or saddle back in the lumbar spine), or inversion of these curves, can cause spinal stenosis and pinched nerves and/or blood vessel occlusion and ischaemia (where circulation is cut off in an area as blood vessels are compressed).
Symptoms of CTJ Deformity
Pinched nerves in the neck may cause symptoms of paraesthesia (abnormal sensations like pins and needles) in the chest, arms, neck and head, as well as numbness and weakness in the extremities. Headaches, speech difficulties, problems swallowing and a whole host of other symptoms can arise from pinched nerves in the neck and where the compression is being caused by a cervicothoracic junction deformity it may be necessary to undergo surgery.
Treating Cervical/Thoracic Spine Problems
Some patients suffering neck pain and other symptoms due to a deformity in the cervical and thoracic spine can benefit from a regime of physical therapy, strengthening and stretching neck exercises and spinal braces or other supports to help rebalance the spine. Severe malformation, spinal slippage and disc herniation leading to loss of intervertebral height may all necessitate more invasive action to correct the problems. The type of neck surgery to be carried out will depend on the patient’s specific circumstances and health. Some minimally invasive procedures can help reduce nerve compression by removing osteophytes or herniated disc fragments but other, more invasive surgeries may be required if the spine needs more extensive realignment, fusion and removal of discs and/or bone.
Surgery for Cervicothoracic Junction Kyphosis
Sagittal plane deformities may benefit from pedicle subtraction osteotomy, where bone is removed from a specific region of the vertebra, along with interlaminar Smith-Petersen osteotomies to close the gap in the vertebra once the bone has been removed. These kinds of osteotomies are usually applied in the lower back (lumbar spine), with some done on the thoracic region but very few in the cervical spine. It is still a pretty novel procedure to use a PSO to correct CTJ deformity, restore forward gaze and reduce neck pain and other symptoms resulting from the kyphosis.
Causes of CTJ Dysfunction
A pedicle subtraction osteotomy may be indicated after a patient has experienced postlaminectomy kyphosis, spinal cord tumor resection, or in degenerative arthritis of the cervical spine. This kind of procedure may be done in isolation on one segment of the spine or it could be performed across spinal segments for a wider impact where more extensive correction is needed. A single procedure or multistage operations may be necessary to properly realign the cervical and thoracic spine.
Relieving Neck Pain from CTJ Deformity
Following a PSO for cervicothoracic junction kyphosis, patients will usually experience significant relief in symptoms of nerve compression, as well as an improved spinal alignment allowing them to maintain a preferred forward gaze. Early correction is usually optimal in order to reduce the impact on other, nearby, spinal segments and so anyone suspecting a problem is advised to seek medical attention to investigate potential symptoms of cervicothoracic junction kyphosis.
Samudrala S, Vaynman S, Thiayananthan T, Ghostine S, Bergey DL, Anand N, Pashman RS, Johnson JP. Cervicothoracic junction kyphosis: surgical reconstruction with pedicle subtraction osteotomy and Smith-Petersen osteotomy. Presented at the 2009 Joint Spine Section Meeting. Clinical article. J Neurosurg Spine. 2010 Dec;13(6):695-706.