This is a patient with a chin on chest deformity because of the abnormal curve in the neck and upper back.
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Cervical deformity is an abnormal curve or angulation in the normally smoothly curved neck. The cause is degenerative facet or disc disease at multiple levels.
The normal neck alignment in the front to back view should be straight up and down and from the side, should display a backwards curve called a lordosis. The lordosis is caused by the trapezoidal shape of the discs. The bodies of the vertebra are square and stacking them up on top of each other without the discs and facets would form a straight tower.
If the discs or facets break down (and they normally do), but break down asymmetrically, an abnormal alignment or cervical deformity occurs. If this breakdown occurs at only one level, the malalignment rarely causes an abnormal curve. If this breakdown occurs at multiple levels, the affect is additive. One level's abnormal angulation will add to the abnormal angulation above and below to cause a scoliosis or a degenerative kyphosis (an opposite curve compared to the natural lordosis).
Symptoms
This abnormal curve causes the head to be held in an unusual posture when the neck is in a "relaxed" position. Muscle contraction is needed to hold the head in a normal position with chin neutral and eyes level. Chronic muscle contraction causes a dull crampy type of neck pain that is relieved with lying down.
Of course, pain from the normal degenerative conditions that also cause cervical deformity can occur in each segment. That is-a bad disc or facet can cause nerve compression; disc pain, instability, degenerative spondylolysthesis as well as central stenosis and myelopathy (see each section for description of that disorder).
Treatment
Non-surgical
Standard conservative treatment for cervical deformity includes physical therapy, Chiropractic treatment, medications, home traction, massage and injections when necessary.
Surgical
Surgical treatment depends upon the size of the cervical deformity present and what is causing the pain. It may be that the deformity by itself is not causing pain and it is a simple matter to fix a herniated disc or bone spurs compressing a nerve root. If deformity surgery is necessary, the surgery may be performed strictly from the front (an ADCF), from the back (a posterior fusion) or from both sides (a 360).
For more information on cervical deformity, or for additional resources on orthopedic spine surgery, please contact Dr. Donald Corenman at 970-479-5895.
