The main objective of surgery to correct cervical kyphosis is to achieve a straight-ahead gaze for patients. While this goal might sound simple and straightforward, the surgery and recovery are anything but.
Lee Riley, III, executive vice chairman in the Johns Hopkins Department of Orthopaedic Surgery, specializes in cervical spine revisions and deformities such as spondylosis, degenerative disc disease and severe hyperkyphoses such as chin-on-chest deformities. He says the procedures to correct chin-on-chest deformities often take 10 to 12 hours and involve a posterior approach to the neck, followed by an anterior approach, and then another posterior approach.
“It’s basically three operations under the same anesthetic,” says Riley. “Part of the challenge is determining how to execute the surgery from a technical and sequencing standpoint and understanding what you can accomplish in one sitting. You have to consider the merits of staging, and you need to anticipate complications both during and after the operation.”
To correct cervical kyphosis, Riley first uses a posterior approach to loosen the joints in the back of the neck, decompressing the nerves. He then inserts screws as fixation points. In an anterior stage, Riley makes a small incision, advances past the esophagus, trachea and blood vessels, and removes discs or part of the bone, which allows him to mobilize the patient’s neck. He then adds structural bone, which he says acts “kind of like a doorjamb that allows the bone to heal together but also provides structural support.” In the final posterior stage, Riley repositions the neck using screws, rods and bone graft.
“The difficulty,” Riley says, “is that all of this manipulation must be performed within the constraints of how much manipulation the nerves and spinal cord can tolerate. You have to maximize the space for the nerves and the spinal cord to move in order to avoid paralysis or damage to the spinal cord.”
For patients, the six- to 12-month long recovery process can be very difficult. “Helping patients understand preoperatively what they are committing themselves to and then making a commitment to them that you will get them through the operation is really important,” says Riley.
Postoperatively, Riley monitors for instrumentation failure, infection and nerve injury. Because the patient will likely require a gastric feeding tube for a period of time after surgery, swallowing and speech therapists are involved during the early postoperative period. These therapists can help advise patients on steps they can take to avoid complications such as aspiration and pneumonia.
“We have tremendous resources available here at Hopkins—cutting-edge equipment, operating rooms, intensive care units, as well as skilled intensivists,” says Riley. “Everyone is committed to expert, patient-centered care.”