The cervical spine normally has a gentle forward curve that helps support the head and distribute stress across the neck. Cervical deformity occurs when this normal alignment is lost or when the head, neck, and upper spine become abnormally positioned.
Please review the Cervical spine anatomy section for more information.
A cervical deformity may develop gradually from degeneration, previous surgery, inflammatory disease, congenital abnormalities, neuromuscular conditions, or trauma. Some deformities cause primarily neck pain and fatigue. Others may lead to difficulty holding the head upright, trouble seeing forward, swallowing problems, nerve compression, spinal cord compression, or progressive neurological dysfunction.
Major Diagnosis Types
Below are the major types we see in our clinic. Click on available links to learn about our approach to the problems.
Adult Cervical Deformity
Basket term for abnormal alignment of the neck.
Can be abnormal forward bend, abnormal side-to-side curvature, translation between vertebral bodies, ore a combination of these problems.
Minor Diagnosis Types
These terms are often encountered, but are either less often treated or described within one of the above diagnoses.
Cervical Hyperlordosis
Cervical hyperlordosis is an exaggerated forward curvature of the cervical spine.
It may develop as a compensatory response to deformity elsewhere in the spine. For example, a patient with thoracic kyphosis or forward sagittal imbalance may increase the cervical curve to keep the eyes level.
Hyperlordosis may contribute to:
- Posterior neck pain
- Facet joint stress
- Muscle fatigue
- Foraminal narrowing
- Abnormal head posture
It may also be associated with certain congenital, neuromuscular, or postural conditions.
Cervical Kyphosis
Cervical kyphosis occurs when the normal forward curve of the neck becomes straightened or reverses into a backward curve.
A mild loss of cervical lordosis is common and may occur from muscle spasm, positioning, or degeneration. True structural kyphosis is more significant and may alter the mechanics of the cervical spine.
Possible causes include:
- Degenerative disc disease
- Vertebral collapse
- Previous cervical surgery
- Trauma
- Infection
- Tumor
- Congenital abnormalities
- Inflammatory disease
- Neuromuscular weakness
Cervical kyphosis may cause pain, fatigue, difficulty maintaining horizontal gaze, or compression of the spinal cord.
Cervical Scoliosis
Cervical scoliosis is an abnormal side-to-side curvature of the cervical spine.
This condition is uncommon compared with thoracic or lumbar scoliosis. It may occur by itself or as part of a larger spinal deformity.
Possible causes include:
- Congenital vertebral abnormalities
- Neuromuscular disease
- Previous surgery
- Trauma
- Tumor
- Degenerative changes
- Compensatory changes from thoracic deformity
Symptoms may include:
- Head tilt
- Uneven shoulders
- Neck pain
- Muscle imbalance
- Limited motion
- Difficulty maintaining a level gaze
The clinical importance depends on the severity of the curve and whether it affects neurological structures.
Cervical Sagittal Imbalance
Cervical sagittal imbalance occurs when the head shifts too far forward relative to the shoulders and upper spine.
The body normally uses several spinal curves to keep the head balanced over the pelvis and the eyes facing forward. When this balance is lost, the neck muscles may have to work continuously to support the head.
Symptoms may include:
- Neck fatigue
- Muscle pain
- Difficulty holding the head upright
- Reduced walking tolerance
- Difficulty looking forward
- Compensatory bending of the knees or hips
- Progressive functional limitation
Cervical sagittal imbalance may develop from a problem within the neck or as compensation for thoracic or global spinal deformity.
Cervicothoracic Deformity
Cervicothoracic deformity occurs near the junction between the cervical and thoracic spine.
Because this region connects the mobile neck to the more rigid upper back, deformity here can have a major effect on head position and horizontal gaze.
Possible causes include:
- Degeneration
- Previous fusion
- Fracture
- Tumor
- Infection
- Congenital abnormalities
- Ankylosing conditions
Cervicothoracic deformity may cause:
- Forward head posture
- Neck and upper-back pain
- Shoulder imbalance
- Difficulty looking forward
- Spinal cord or nerve compression
Some patients compensate by extending the upper cervical spine, which may lead to additional pain and fatigue.
Chin-on-Chest Deformity
Chin-on-chest deformity is a severe form of forward cervical flexion in which the chin moves toward or rests against the chest.
This deformity may be flexible at first but can become rigid over time.
Possible causes include:
- Neuromuscular weakness
- Dropped head syndrome
- Ankylosing conditions
- Previous surgery
- Severe degeneration
- Parkinsonian disorders
- Inflammatory disease
- Radiation-related muscle injury
Patients may experience:
- Inability to look forward
- Difficulty eating or swallowing
- Trouble speaking
- Skin irritation beneath the chin
- Severe neck pain
- Difficulty walking safely
- Social and functional impairment
This is often a complex deformity involving both the cervical and upper thoracic spine.
Congenital Cervical Deformity
Congenital cervical deformities are caused by differences in spinal development present from birth.
Examples include:
- Hemivertebrae
- Block vertebrae
- Segmentation abnormalities
- Klippel-Feil syndrome
- Congenital scoliosis
- Congenital kyphosis
- Abnormal craniovertebral junction anatomy
Some congenital deformities remain mild and stable. Others may progress during growth or contribute to early degeneration, instability, or neurological compression.
Neuromuscular Cervical Deformity
Neuromuscular cervical deformity develops when the muscles responsible for supporting and controlling the neck become weak, imbalanced, or abnormally active.
Possible causes include:
- Muscular disorders
- Motor neuron disease
- Parkinsonian disorders
- Dystonia
- Myopathy
- Peripheral nerve disorders
- Prior radiation
- Severe deconditioning
Patients may develop dropped head syndrome, progressive forward flexion, painful muscle fatigue, or difficulty maintaining horizontal gaze.
The deformity may initially improve when lying down but can become fixed over time.
Post-Laminectomy Cervical Deformity
Post-laminectomy cervical deformity may develop after removal of the posterior supporting structures of the cervical spine.
A laminectomy creates more space for the spinal cord, but removing bone and disrupting supporting tissues may reduce stability in selected patients.
Over time, the cervical spine may gradually lose its normal curve and develop kyphosis.
Risk factors may include:
- Young age
- Preexisting loss of lordosis
- Multilevel decompression
- Facet joint injury
- Muscle detachment
- Poor bone quality
- Previous radiation
Post-laminectomy deformity may cause pain, instability, recurrent spinal cord compression, or neurological decline.
Post-Fusion Cervical Deformity
A cervical deformity may develop after a previous spinal fusion if the spine heals in abnormal alignment or if the levels next to the fusion degenerate.
Possible postoperative problems include:
- Fusion in excessive kyphosis
- Loss of cervical lordosis
- Junctional kyphosis
- Implant subsidence
- Failure of fusion
- Hardware loosening
- Adjacent segment degeneration
- Progressive global imbalance
Some postoperative alignment changes cause no symptoms. Others may produce pain, difficulty maintaining gaze, nerve compression, or spinal cord dysfunction.