Most patients familiar with cervical spine problems think of disc herniation, nerve compression, or stenosis. Cervical kyphosis is less widely known but represents a distinct and clinically important problem: the neck loses its normal inward curve and develops a forward bend instead, placing the spinal cord under progressive stretch across the kyphotic apex and creating a pattern of neurological deterioration that differs from simple disc disease.
What Is Cervical Kyphosis?
The normal cervical spine has a lordotic curve — it curves inward (toward the back of the throat) when viewed from the side. This lordosis distributes compressive loads evenly across the disc spaces and keeps the spinal cord in a relaxed, non-stretched state. When cervical lordosis is lost and the cervical spine develops a kyphotic curve instead — bending forward — several problems arise:
- The spinal cord must drape over the kyphotic apex, stretching and compressing it from the front
- The disc spaces at the apex of the kyphosis undergo excessive anterior loading, accelerating degeneration
- The posterior muscles of the neck must work continuously to maintain head position, producing chronic muscle fatigue and pain
- The natural tendency of the kyphosis is to progress over time as the disc spaces at the apex continue to degenerate under abnormal loading
Causes
Post-Surgical (Post-Laminectomy)
The most common cause of iatrogenic cervical kyphosis. Cervical laminectomy removes the posterior bony arches — and in doing so, disrupts the posterior tension band that maintains lordosis. Without this posterior restraint, the cervical spine can progressively fall into kyphosis, particularly at levels where the disc spaces are already degenerated or where pre-existing lordosis was reduced. Post-laminectomy kyphosis is one of the principal reasons that cervical laminoplasty has largely replaced multilevel laminectomy at centers where both are available.
Degenerative
Cervical spondylosis with multilevel disc height loss can produce a loss of lordosis or frank kyphosis as the disc spaces collapse and the anterior column shortens. This is typically a gradual process and may be an incidental finding on imaging in patients with mild disease, or may contribute to progressive myelopathy in patients with more severe degeneration and cord compression.
Congenital and Developmental
Some patients develop cervical kyphosis from congenital vertebral anomalies, failure of anterior vertebral body development, or conditions such as neurofibromatosis. These are less common causes but can produce severe cervical deformity requiring complex anterior and posterior reconstruction.
Inflammatory (Ankylosing Spondylitis)
Ankylosing spondylitis — a seronegative inflammatory arthropathy — can produce a chin-on-chest deformity as the cervical spine progressively ankylovers in kyphosis. This is one of the most severe forms of cervical kyphosis and requires specific surgical approaches designed for the inflammatory, fused spine.
Why Cervical Kyphosis Is Neurologically Urgent
Spinal cord compression from cervical kyphosis can be more insidious than compression from disc herniation. With disc herniation, compression is localized; with kyphosis, the cord is compressed over a longer segment and stretched over the kyphotic apex. This combination produces a myelopathy pattern that may not respond as well to simple decompression — because decompression without correction of the kyphosis leaves the cord still draped over the kyphotic apex, still under tension.
Any patient with cervical kyphosis and progressive neurological symptoms — hand clumsiness, gait instability, balance problems, Lhermitte’s sign — requires urgent evaluation including MRI to assess cord signal. Cord signal change on MRI indicates established injury to the cord and argues for expedited surgical planning rather than prolonged observation. For more on cervical myelopathy and why early recognition matters, see the dedicated page.
Surgical Correction
Cervical kyphosis correction can involve a combination of anterior and posterior approaches to address both the structural kyphosis (anterior column reconstruction to restore lordosis) and the posterior stability (instrumented fusion to hold the corrected position). For flexible kyphosis, posterior-only correction with lateral mass or pedicle screw fixation may be sufficient.
Intraoperative neuromonitoring throughout the entire correction procedure is absolutely non-negotiable — the spinal cord is at risk during both the decompression and the correction maneuver, and real-time monitoring provides the only reliable warning if the cord is being compromised during surgery. For more on kyphosis surgical techniques, see the Kyphosis Surgery page.
About Dr. Zeeshan Sardar
Dr. Sardar, MD, MSc, F.R.C.S.C, is Co-Chief of Spinal Deformity Surgery at NewYork-Presbyterian / Columbia University, evaluating and treating cervical kyphosis including post-surgical, degenerative, and complex reconstruction cases. To schedule a consultation, call 212-932-5187 or visit the contact page.
This post is for educational purposes only and does not constitute individualized medical advice.