Progressive Adolescent Idiopathic Cervical Kyphosis Secondary to Constant Postural Neck Flexion Reading Habit with a 10-year Follow-up: Case Report and Literature Review

Abstract

Background: Although it has been established that adolescent idiopathic cervical kyphosis (AICK) has no known cause, there are associated risk factors. However, the underlying causes remain puzzling. This case report presents severe AICK linked to chronic neck flexion postural habit, treated with combined anterior and posterior correction surgery and review of the literature. Case presentation: A 16-year-old male with no history of trauma, surgery, or family history of spinal deformity complained of intolerable neck pain and rigidity. He developed an incessant reading of comic books at a very young age, and he preferred placing the book on the floor with his head flexed between his thighs. Acupuncture and massage therapy failed to relief symptoms. He had no neurological symptoms on examination and X-ray showed Cobb angle of 70.5°. MRI and CT scans showed no spinal cord compression or osteophyte formation. A combined anterior and posterior correction surgery was performed after a week of skull traction. The deformity was corrected, neck pain disappeared, and neck rotatory function maintained after posterior implant removal. The maximum follow-up was 10 years. Conclusions: The potential underlying risk factor observed in this case is unusual. Chronic neck flexion postural habit is a potential risk factor of severe AICK in some individuals.