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Complications and Outcomes for Surgical Approaches to Cervical Kyphosis

Study Design: Retrospective cohort study. Objective: The primary objective of this study is to report the safety and efficacy of the different surgical approaches to cervical deformity correction surgery. Summary of Background Data: Cervical subaxial deformity surgery has been shown to be an effective means to alleviate pain and improve neurological function in symptomatic patients. The reported outcomes and complications for the different surgical approaches (ventral, dorsal, and combined) are limited to small retrospective studies. The appropriate surgical approach is at times unclear, which is likely attributed to the overlap in indications for the ventral and combined approach. Materials and Methods: A retrospective review of 76 patients who underwent cervical deformity surgery for cervical kyphosis at 1 institution was performed. The authors reviewed the complications, radiographic outcomes, and long-term functional outcomes for all patients. Results: The majority of patients in all groups reported excellent (15%) or good (50%) outcomes, with a mean improvement in modified Japanese orthopedic association score of 1.3. There were 26 perioperative complications (34%) for 19 patients (25%). We found the ventral-alone and combined approaches to achieve similar degrees of correction (23.1 and 23.2 degrees, respectively). The combined approach had the highest complication rate of the 3 approaches (combined: 40%, ventral: 30%, dorsal: 27%). The dorsal, ventral, and combined approaches had a mean neurological improvement in modified Japanese orthopedic association scores of 1.95, 3.00, and 1.26, respectively, and mean pain improvement of 0.8, 2.0, and 1.4. Conclusions: Given the moderate improvements in long-term outcomes, and the risks for perioperative complications, we recommend a careful selection process for patients eligible for cervical deformity surgery. We found that the ventral approach has reduced complications, similar degree of correction capability, and potentially higher improved neurological outcomes compared to the combined approach.