scholarly journals Diagnostic Accuracy of Magnetic Resonance Imaging for Sagittal Cervical Spine Alignment: A Retrospective Cohort Study

2021 ◽  
Vol 18 (24) ◽  
pp. 13033
Author(s):  
Chahyun Oh ◽  
Chan Noh ◽  
Jieun Lee ◽  
Sangmin Lee ◽  
Boohwi Hong ◽  
...  
Keyword(s):  
Cobb Angle ◽  
Rotation Angle ◽  
Vertical Axis ◽  
Resonance Imaging ◽  
Sagittal Vertical Axis ◽  
Predictive Values ◽  
Cervical Alignment ◽  
The Subject ◽  
Cervical Spine Alignment ◽  
Mri Measurements

(1) Background: Although radiography performed on the subject in an upright position is considered the standard method for assessing sagittal cervical alignment, it is frequently determined, or reported, based on MRI performed on the subject in a supine position. (2) Methods: Cervical alignment observed in both imaging modalities was assessed using four methods: the C2-7 Cobb angle, the absolute rotation angle (ARA), Borden’s method, and the sagittal vertical axis (SVA). Cervical alignment was determined (lordosis, kyphosis, and straight) based on radiography. Then, the diagnostic cut-off values for the MRI images and their corresponding diagnostic accuracies were assessed. (3) Results: The analysis included 142 outpatients. The determined diagnostic cut-off values for lordosis, using three measurements (Cobb angle, ARA, and Borden’s method), were −8.5°, −12.5°, and 3.5 mm, respectively, and the cut-off values for kyphosis were −4.5°, 0.5°, and −1.5 mm, respectively. The cut-off value for SVA > 40 mm was 19.5 mm. The Cobb angle, ARA, and Borden’s method, on MRI, showed high negative predictive values for determining kyphosis. The SVA on MRI measurements also showed high negative predictive values for determining >40 mm. (4) Conclusions: MRI measurements may be predictive of cervical alignment, especially for the exclusion of kyphosis and SVA > 40 mm. However, caution is needed in the other determinations using MRI, as their accuracies are limited.

scholarly journals Cervical Spine Alignment in the Sagittal Axis: A Review of the Best Validated Measures in Clinical Practice

2020 ◽  
pp. 219256822097207
Author(s):  
Michael L. Martini ◽  
Sean N. Neifert ◽  
Emily K. Chapman ◽  
Thomas E. Mroz ◽  
Jonathan J. Rasouli
Keyword(s):  
Cervical Spine ◽  
Cobb Angle ◽  
Vertical Axis ◽  
The Elderly ◽  
Sagittal Vertical Axis ◽  
Technical Literature ◽  
Related Quality ◽  
Health Related ◽  
Cervical Spinal Alignment ◽  
Cervical Spine Alignment

Study Design: Review of the best-validated measures of cervical spine alignment in the sagittal axis. Objective: Describe the C2-C7 Cobb Angle, C2-C7 sagittal vertical axis, chin-brow to vertical angle, T1 slope minus C2-C7 lordosis, C2 slope, and different types of cervical kyphosis. Methods: Search PubMed for recent technical literature on radiograph-based measurements of the cervical spine. Results: Despite the continuing use of measures developed many years ago such as the C2-C7 Cobb angle, there are new radiographic parameters being published and utilized in recent years, including the C2 slope. Further research is needed to compare older and newer measures for cross-validation. Utilizing these measures to determine the degree of correction intraoperatively and postoperatively will enable surgeons to optimize patient-level outcomes. Conclusion: Cervical spinal deformity can be a debilitating condition characterized by cervical spinal misalignment that affects the elderly more commonly than young populations. Many of these validated measures of cervical spinal alignment are useful in clinical settings due to their ease of implementation and correlations with various postoperative and health-related quality of life outcomes.

scholarly journals Sagittal profile modifications in hybrid versus all screw technique in adolescent idiopathic scoliosis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Laura Scaramuzzo ◽  
Antonino Zagra ◽  
Giuseppe Barone ◽  
Stefano Muzzi ◽  
Leone Minoia ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Thoracic Kyphosis ◽  
Sagittal Alignment ◽  
Vertical Axis ◽  
Sagittal Profile ◽  
Sacral Slope ◽  
Sagittal Vertical Axis ◽  
Lenke Classification

AbstractAim of the study was to evaluate sagittal parameters modifications, with particular interest in thoracic kyphosis, in patients affected by adolescent idiopathic scoliosis (AIS) comparing hybrid and all-screws technique. From June 2010 to September 2018, 145 patients were enrolled. Evaluation included: Lenke classification, Risser scale, coronal Cobb angle, thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS). Patients were divided in two groups (1 all-screws and 2 hybrid); a further division, in both groups, was done considering preoperative TK values. Descriptive and inferential statistical analysis was conducted. 99 patients were in group 1, 46 in group 2 (mean follow-up 3.7 years). Patients with a normo-kyphotic profile developed a little variation in TK (Δ pre–post = 2.4° versus − 2.0° respectively). Hyper-kyphotic subgroups had a tendency of restoring a good sagittal alignment. Hypo-kyphotic subgroups, patients treated with all-screw implants developed a higher increase in TK mean Cobb angle (Δ pre–post = 10°) than the hybrid subgroup (Δ pre–post = 5.4°) (p = 0.01). All-screws group showed better results in restoring sagittal alignment in all subgroups compared to hybrid groups, especially in hypo-TK subgroup, with the important advantage to give better correction on coronal plane.

scholarly journals Accuracy and Reliability of X-ray Measurements in the Cervical Spine

2020 ◽  
Vol 14 (2) ◽  
pp. 169-176
Author(s):  
Catarina Marques ◽  
Emma Granström ◽  
Anna MacDowall ◽  
Nuno Canto Moreira ◽  
Martin Skeppholm ◽  
...  
Keyword(s):  
Cobb Angle ◽  
Controlled Trial ◽  
Intraclass Correlation ◽  
Vertical Axis ◽  
Minimal Detectable Change ◽  
Detectable Change ◽  
Sagittal Vertical Axis ◽  
Minimum Detectable Change ◽  
Spine Surgeon ◽  
Segmental Angle

Study Design: This study is a post hoc analysis of a multicenter prospective randomized controlled trial which compared artificial disc replacement and anterior cervical discectomy and fusion.Purpose: Useful radiographic parameters for assessing cervical alignment include the Cobb angles, T1 slope (T1S), occipitocervical inclination (OCI), K-line tilt (KLT), and cervical sagittal vertical axis (cSVA). This study aimed to determine measurement accuracy and reliability for these parameters.Overview of Literature: Various authors have assessed repeatability by comparing different methods of measurement, but knowledge of measurement error and minimal detectable change is scarce.Methods: We evaluated 758 lateral cervical radiographs. One medical student and one spine surgeon (i.e., measured ×2 within 4 weeks) independently measured the parameters obtaining 5,850 values. Standard error of measurement (SEm) and minimum detectable change (MDC) were calculated for each parameter. The accuracy and reliability of the Cobb angle measurements were calculated for the different types of angles: cervical lordosis, prosthesis angle, segmental angle with two bone surfaces (SABB), and segmental angle with one bone and one metal surface. Reliability was determined with intraclass correlation coefficient (ICC).Results: SEm was 1.8° and MDC was 5.0° for the Cobb angle, with an intraobserver/interobserver ICC of 0.958/0.886. All the different subtypes of Cobb angles had an ICC higher than 0.950, except SABB (intraobserver/interobserver ICC of 0.922/0.716). The most accurate and reliable measurement was for KLT.Conclusions: This study provides normative data on SEm and MDC for Cobb angles, T1S, KLT, OCI, and cSVA in cervical lateral radiographs. Reliability was excellent for all parameters except SABB (e.g., good).

The case for T2 pedicle subtraction osteotomy in the surgical treatment of rigid cervicothoracic deformity

2020 ◽  
Vol 32 (2) ◽  
pp. 248-257 ◽  
Author(s):  
Frank J. Yuk ◽  
Jonathan J. Rasouli ◽  
Marc S. Arginteanu ◽  
Alfred A. Steinberger ◽  
Frank M. Moore ◽  
...  
Keyword(s):  
Cobb Angle ◽  
Vertical Axis ◽  
Chronic Neck Pain ◽  
Pedicle Subtraction Osteotomy ◽  
Neurological Complications ◽  
Sagittal Vertical Axis ◽  
Radiographic Measurements ◽  
Correction Technique ◽  
Estimated Blood Loss ◽  
Cervical Surgery

OBJECTIVERigid cervicothoracic kyphotic deformity (CTKD) remains a difficult pathology to treat, especially in the setting of prior cervical instrumentation and fusion. CTKD may result in chronic neck pain, difficulty maintaining horizontal gaze, and myelopathy. Prior studies have advocated for the use of C7 or T1 pedicle subtraction osteotomies (PSOs). However, these surgeries are fraught with danger and, most significantly, place the C7, C8, and/or T1 nerve roots at risk.METHODSThe authors retrospectively reviewed their experience with performing T2 PSO for the correction of rigid CTKD. Demographics collected included age, sex, details of prior cervical surgery, and coexisting conditions. Perioperative variables included levels decompressed, levels instrumented, estimated blood loss, length of surgery, length of stay, complications from surgery, and length of follow-up. Radiographic measurements included C2–7 sagittal vertical axis (SVA) correction, and changes in the cervicothoracic Cobb angle, lumbar lordosis, and C2–S1 SVA.RESULTSFour male patients were identified (age range 55–72 years). Three patients had undergone prior posterior cervical laminectomy and instrumented fusion and developed postsurgical kyphosis. All patients underwent T2 PSO: 2 patients received instrumentation at C2–T4, and 2 patients received instrumentation at C2–T5. The median C2–7 SVA correction was 3.85 cm (range 2.9–5.3 cm). The sagittal Cobb angle correction ranged from 27.8° to 37.6°. Notably, there were no neurological complications.CONCLUSIONST2 PSO is a powerful correction technique for the treatment of rigid CTKD. Compared with C7 or T1 PSO, there is decreased risk of injury to intrinsic hand muscle innervators, and there is virtually no risk of vertebral artery injury. Laminectomy may also be safer, as there is less (or no) scar tissue from prior surgeries. Correction at this distal level may allow for a greater sagittal correction. The authors are optimistic that these findings will be corroborated in larger cohorts examining this challenging clinical entity.

scholarly journals Long-term efficacy and safety of bone cement-augmented pedicle screw fixation for stage III Kümmell disease

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Guo-ye Mo ◽  
Teng-peng Zhou ◽  
Hui-zhi Guo ◽  
Yong-xian Li ◽  
Yong-chao Tang ◽  
...  
Keyword(s):  
Cobb Angle ◽  
Bone Cement ◽  
Pedicle Screw ◽  
Screw Fixation ◽  
Operation Time ◽  
Vertical Axis ◽  
Pedicle Screw Fixation ◽  
Stage Iii ◽  
Efficacy And Safety ◽  
Sagittal Vertical Axis

AbstractThis study aimed to evaluate the efficacy and safety of bone cement-augmented pedicle screw fixation for stage III Kümmell disease. Twenty-five patients with stage III Kümmell disease who received bone cement-augmented pedicle screw fixation at the First Affiliated Hospital of Guangzhou University of Chinese Medicine between June 2009 and December 2015 were enrolled. All patients were females with a history of osteoporosis. The vertebral Cobb angle (V-Cobb angle), the fixed segment Cobb Angle (S-Cobb angle), pelvic parameters, visual Analogue Scale (VAS) score, and Oswestry Disability Index (ODI) were assessed preoperatively, postoperatively and at the final follow-up. Complications, loosening rate, operation time, and intraoperative bleeding were recorded. The average lumbar vertebral density T-value was − 3.68 ± 0.71 SD, and the average age was 71.84 ± 5.39. The V-Cobb angle, S-Cobb angle, and Sagittal Vertical Axis (SVA) were significantly smaller postoperatively compared to the preoperative values. The VAS and ODI at 1 month after surgery were 3.60 ± 1.00 and 36.04 ± 6.12%, respectively, which were both significantly lower than before surgery (VAS: 8.56 ± 1.04, ODI: 77.80 ± 6.57%). Bone cement-augmented pedicle screw fixation is a safe and effective treatment for stage III Kümmell disease. It can effectively correct kyphosis, restore and maintain sagittal balance, and maintain spinal stability.

scholarly journals Cervical, Thoracic, and Spinopelvic Compensation After Proximal Junctional Kyphosis (PJK): Does Location of PJK Matter?

2019 ◽  
Vol 10 (1) ◽  
pp. 6-12 ◽  
Author(s):  
Han Jo Kim ◽  
Philip J. York ◽  
Jonathan C. Elysee ◽  
Christopher Shaffrey ◽  
Douglas C. Burton ◽  
...  
Keyword(s):  
Correlation Analysis ◽  
Case Series ◽  
Vertical Axis ◽  
Global Alignment ◽  
Proximal Junctional Kyphosis ◽  
Retrospective Case ◽  
Sagittal Vertical Axis ◽  
Cervical Alignment ◽  
Compensation Mechanisms ◽  
Junctional Kyphosis

Study Design: Retrospective case series. Objective: Compensatory changes above a proximal junctional kyphosis (PJK) have not been defined. Understanding these mechanisms may help determine optimal level selection when performing revision for PJK. This study investigates how varying PJK location changes proximal spinal alignment. Methods: Patients were grouped by upper instrumented vertebrae (UIV): lower thoracic (LT; T8-L1) or upper thoracic (UT; T1-7). Alignment parameters were compared. Correlation analysis was performed between PJK magnitude and global/cervical alignment. Results: A total of 369 patients were included; mean age of 63 years, body mass index 28, and 81% female, LT (n = 193) versus UT (n = 176). The rate of radiographic PJK was 49%, higher in the LT group (55% vs 42%, P = .01). The UT group displayed significant differences in all cervical radiographic parameters ( P < .05) between PJK versus non-PJK patients, while the LT group displayed significant differences in T1S and C2-T3 sagittal vertical axis (SVA) (CTS). In comparing UT versus LT patients, UT had more posterior global alignment (smaller TPA [T1 pelvic angle], SVA, and larger PT [pelvic tilt]) and larger anterior cervical alignment (greater cSVA [cervical SVA], T1S-CL [T1 slope–cervical lordosis] mismatch, CTS) compared to LT. Correlation analysis of PJK magnitude and location demonstrated a correlation with increases in CL, T1S, and CTS in the UT group. In the LT group, PT increased with PJK angle ( r = 0.17) and no significant correlations were noted to SVA, cSVA, or T1S-CL. Conclusions: PJK location influences compensation mechanisms of the cervical and thoracic spine. LT PJK results in increased PT and CL with decreased CTS. UT PJK increases CL to counter increases in T1S with continued T1S-CL mismatch and elevated cSVA.

scholarly journals Contribution of the Mesencephalon Indices to Differential Diagnosis of Parkinsonian Disorders

2020 ◽  
Vol 71 (1) ◽  
pp. 100-109
Author(s):  
Cemil Oktay ◽  
S. Sibel Özkaynak ◽  
Esma Eseroğlu ◽  
Kamil Karaali
Keyword(s):  
Magnetic Resonance ◽  
Matched Control ◽  
Resonance Imaging ◽  
Mr Images ◽  
Predictive Values ◽  
Parkinsonian Disorders ◽  
Cerebellar Peduncles ◽  
Diagnostic Power ◽  
Magnetic Resonance Imaging Mri ◽  
Mri Measurements

Background and Purpose: This study aimed to assess the sensitivity and specificity of brain stem morphologic changes to differentiate the progressive supranuclear palsy (PSP) from Parkinson disease (PD) and multiple system atrophy (MSA), by single and combined magnetic resonance imaging (MRI) measurements. Materials and Methods: Peduncle angle (PA), pons area (P), mesencephalon area (M), middle cerebellar peduncles (MCPs), and superior cerebellar peduncles (SCPs) were measured in 14 PSP, 43 PD, 8 MSA patients, and 45 age-matched control participants on T1-weighted MRI. Neurologists clinically diagnosed all patients. Additionally, P/M ratio, MCPs/SCPs ratio, the previously defined Magnetic Resonance Parkinsonism Index, MRPI: (P/M) · (MCP/SCP), and also the Akdeniz Index (AKI) that we termed were calculated, AKI: (P/M) · (PA/180). Two blinded radiologists evaluated all MR images and inter-/intraobserver variations were measured. Results: Both M and SCPs were significantly lower and P/M, MCPs/SCPs, and PA were significantly higher in PSP patients than the other groups ( P < .001). This significance was related to patients with PSP and PD. But all single measurements showed some overlapping values. Therefore, previously defined MRPI was calculated and shown to distinguish patients (negative predictive values: 92%, sensitivity: 78%, specificity: 82%). In this study, interobserver correlation (0.68) was found low for MRPI. Therefore, we identified a more practical index: the Akdeniz Index, which has same diagnostic power with MRPI and higher interobserver correlation (0.91). Conclusion: The Akdeniz Index identified in our study is a practical index with high diagnostic power and can reinforce radiological distinguishing of PSP and PD, which are clinically difficult to distinguish.

scholarly journals Efficacy of Modified Cervical and Shoulder Retraction Exercise in Patients With Loss of Cervical Lordosis and Neck Pain

2020 ◽  
Vol 44 (3) ◽  
pp. 210-217
Author(s):  
Min Yong Lee ◽  
Heewon Jeon ◽  
Ji Soo Choi ◽  
Yulhyun Park ◽  
Ju Seok Ryu
Keyword(s):  
Neck Pain ◽  
Age Groups ◽  
Exercise Program ◽  
Vertical Axis ◽  
Cervical Lordosis ◽  
Sagittal Vertical Axis ◽  
Cervical Alignment ◽  
Upper Cervical ◽  
Tangent Method ◽  
Cobb’S Angle

Objective To explore if the modified cervical and shoulder retraction exercise program restores cervical lordosis and reduces neck pain in patients with loss of cervical lordosis.Methods This study was a retrospective analysis of prospectively collected data. Eighty-three patients with loss of cervical lordosis were eligible. The eligible patients were trained to perform the modified cervical and shoulder retraction exercise program by a physiatrist, and were scheduled for a follow-up 6 to 8 weeks later to check the post-exercise pain intensity and lateral radiograph of the cervical spine in a comfortable position. The parameters of cervical alignment (4-line Cobb’s angle, posterior tangent method, and sagittal vertical axis) were measured from the lateral radiograph.Results Forty-seven patients were included. The mean age was 48.29±14.47 years. Cervical alignment and neck pain significantly improved after undergoing the modified cervical and shoulder retraction exercise program (p≤0.001). The upper cervical lordotic angle also significantly improved (p=0.001). In a subgroup analysis, which involved dividing the patients into two age groups (<50 years and ≥50 years), the change of the sagittal vertical axis was significantly greater in the <50 years group (p=0.021).Conclusion The modified cervical and shoulder retraction exercise program tends to improve cervical lordosis and neck pain in patients with loss of cervical lordosis.

Scoliosis Research Society-Schwab Grade 6 Osteotomy for Severe Congenital Angular Kyphoscoliosis: An Analysis of 17 Cases With a Minimum 2-Year Follow-up

Neurosurgery ◽  
2020 ◽  
Vol 87 (5) ◽  
pp. 925-930 ◽  
Author(s):  
Bo Shi ◽  
Benlong Shi ◽  
Dun Liu ◽  
Yang Li ◽  
Sanqiang Xia ◽  
...  
Keyword(s):  
Cobb Angle ◽  
Clinical Outcomes ◽  
Vertical Axis ◽  
Research Society ◽  
Sagittal Vertical Axis ◽  
Vertebral Column Resection ◽  
Scoliosis Research Society ◽  
Rod Breakage ◽  
The Mean

Abstract BACKGROUND For some patients with severe congenital angular kyphoscoliosis (SCAK), 1-level vertebral column resection is insufficient and the Scoliosis Research Society (SRS)-Schwab Grade 6 osteotomy may be necessary. However, the indications and clinical outcomes of SRS-Schwab Grade 6 osteotomy in patients with SCAK have not been investigated in depth. OBJECTIVE To investigate the middle-term radiographic and clinical outcomes, and to evaluate the safety of this high technique-demanding procedure. METHODS Patients with SCAK undergoing SRS-Schwab Grade 6 osteotomy from 2005 to 2016 followed up at least 2 yr were retrospectively reviewed. The potential indications of SRS-Schwab Grade 6 osteotomy were analyzed. The coronal Cobb angle, segmental kyphosis (SK), deformity angular ratio (DAR), coronal balance, and sagittal vertical axis (SVA) were measured in the preoperative, postoperative, and final follow-up. The intraoperative and postoperative complications were recorded. RESULTS A total of 17 patients with SCAK (10 M and 7F) were included, and the mean follow-up was 30.8 ± 16.4 mo. The indications of SRS-Schwab Grade 6 osteotomy were as follows: multiple “pushed-out” hemivertebrae (13, 76.5%) and multilevel anterior block (4, 23.5%). Compared with preoperation, the coronal Cobb angle, SK and SVA at postoperation were significantly improved (P &lt; .05 for all). The mean total DAR was 33.4 ± 9.9 at preoperation. Three patients were found to have postoperative neurological deficit. Rod breakage occurred in 3 patients at 15- to 48-mo follow-up, and revision surgeries were performed. At the last follow-up, firm bony fusion was observed in all patients. CONCLUSION The technique-demanding SRS-Schwab Grade 6 osteotomy, if well indicated, could provide satisfying correction of the SCAK deformity.

scholarly journals Increased Neck Tilt/T1 slope ratio may play an important role in patients with cervical kyphosis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Zhibin Lan ◽  
Zhiqiang Wu ◽  
Yuming Huang ◽  
Weihong Xu
Keyword(s):  
Cobb Angle ◽  
Neck Disability Index ◽  
Vertical Axis ◽  
Preoperative Imaging ◽  
Sacral Slope ◽  
Cervical Kyphosis ◽  
Sagittal Vertical Axis ◽  
Clinical Prognosis ◽  
T1 Slope ◽  
Radiographic Measurements

Abstract Background In previous studies, we demonstrated that the T1 slope (T1s) is associated with clinical outcomes, but the results were not specific for individuals. A recent study suggested that an increased pelvic tilt (PT)/sacral slope (SS) ratio may play an important role in the degeneration of lumbar scoliosis and pathogenesis of lumbar spondylolisthesis. Therefore, we aimed to explore the role of neck tilt (NT)/T1s in patients with cervical kyphosis. Methods In total, the data of 36 kyphosis patients who underwent anterior cervical hybrid decompression and fusion (ACHDF) for multilevel (3 levels) cervical spondylotic myelopathy were retrospectively analyzed. The radiographic measurements included the T1s, NT, C2–7 Cobb angle, and C2–7 sagittal vertical axis (SVA). The visual analog scale (VAS) and neck disability index (NDI) scores were used to determine the clinical prognosis. Pearson’s correlation coefficient was calculated to assess the relationships among preoperative imaging examination parameters. Results The mean C2–7 Cobb angle was − 5.93 ± 3.00° before surgery, 9.67 ± 6.61° after surgery, and 7.91 ± 8.73° at the follow-up. The preoperative NT/T1s ratio was positively correlated with the ΔC2–7 Cobb angle (r = 0.358, p < 0.05) and negatively correlated with the preoperative C2–7 Cobb angle (r = -0.515, p < 0.01) and preoperative C2–7 SVA (r = -0.461, p < 0.01). The linear regression model indicated a positive correlation between the preoperative NT/T1s ratio and the ΔC2–7 Cobb angle (R2 = 0.122). Conclusions The preoperative NT/T1s ratio may be positively correlated with changes in postoperative cervical spine curvature (Cobb angle). The NT/T1s ratio may be worthy of increased attention among sagittal parameters.

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