scholarly journals Evaluating Cervical Sagittal Alignment in Cervical Myelopathy: Are Sitting Cervical Radiographs and Standing Whole-Spine Radiographs Equally Useful?

2018 ◽  
Vol 9 (6) ◽  
pp. 591-597
Author(s):  
Yasuhiko Morimoto ◽  
Hideki Shigematsu ◽  
Eiichiro Iwata ◽  
Masato Tanaka ◽  
Akinori Okuda ◽  
...  
Keyword(s):  
Sagittal Alignment ◽  
Horizontal Line ◽  
Radiographic Appearance ◽  
Mean Values ◽  
Cervical Alignment ◽  
T1 Slope ◽  
Cervical Surgery ◽  
Cervical Sagittal Alignment ◽  
The Mean ◽  
Whole Spine

Study Design:Retrospective review of medical charts and radiographic data.Objectives:We aimed to clarify the differences in cervical alignment findings between sitting cervical lateral radiographs and standing whole-spine lateral radiographs with clavicle positioning in cervical spondylotic myelopathy (CSM) patients.Methods:We retrospectively evaluated the radiographs of 50 consecutive patients who underwent cervical surgery for CSM in our hospital. Cervical sagittal alignment was evaluated based on the C0-2 angles and C2-7 Gore and Cobb angles. Head position was evaluated in terms of the center of gravity of the head to C7 (CGH-C7) angle and the McGregor angle (ie, the angle between the McGregor line and a horizontal line). The T1-slope was also evaluated.Results:The mean values of the CGH-C7 angle and T1-slope were significantly lower, while the mean value of the McGregor angle was significantly higher on whole-spine lateral radiographs with clavicle positioning than on sitting cervical lateral radiographs. The mean values of the C0-2 and C2-7 angles did not differ significantly between the 2 radiographic positioning approaches.Conclusions:Using whole-spine lateral radiographs with clavicle positioning may result in a significantly lower T1-slope and a posterior tilt of the head. In the absence of a compensatory change in cervical alignment, clavicle positioning may force patients to adopt an upward gazing position of the head. These compensatory mechanisms should be considered while evaluating cervical alignment on whole-spine lateral radiographs with clavicle positioning. Surgical planning should take into account the effect of posture on the radiographic appearance of cervical alignment.

scholarly journals An assessment of the most reliable method to estimate the sagittal alignment of the cervical spine: analysis of a prospective cohort of 138 cases

2017 ◽  
Vol 26 (5) ◽  
pp. 572-576 ◽  
Author(s):  
Roland D. Donk ◽  
Michael G. Fehlings ◽  
Wim I. M. Verhagen ◽  
Hisse Arnts ◽  
Hans Groenewoud ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Vertebral Body ◽  
Sagittal Balance ◽  
Interrater Reliability ◽  
Sagittal Alignment ◽  
Controlled Trial ◽  
Cervical Alignment ◽  
Cervical Sagittal Alignment ◽  
Tangent Method ◽  
The Mean

OBJECTIVEAlthough there is increasing recognition of the importance of cervical spinal sagittal balance, there is a lack of consensus as to the optimal method to accurately assess the cervical sagittal alignment. Cervical alignment is important for surgical decision making. Sagittal balance of the cervical spine is generally assessed using one of two methods; namely, measuring the angle between C-2 and C-7, and drawing a line between C-2 and C-7. Here, the best method to assess sagittal alignment of the cervical spine is investigated.METHODSData from 138 patients enrolled in a randomized controlled trial (Procon) were analyzed. Two investigators independently measured the angle between C-2 and C-7 by using Harrison's posterior tangent method, and also estimated the shape of the sagittal curve by using a modified Toyama method. The mean angles of each quantitative assessment of the sagittal alignment were calculated and the results were compared. The interrater reliability for both methods was estimated using Cronbach's alpha.RESULTSFor both methods the interrater reliability was high: for the posterior tangent method it was 0.907 and for the modified Toyama technique it was 0.984. For a lordotic cervical spine, defined by the modified Toyama method, the mean angle (defined by Harrison's posterior tangent method) was 23.4° ± 9.9° (range 0.4°–52.4°), for a kyphotic cervical spine it was −2.2° ± 9.2° (range −16.1° to 16.9°), and for a straight cervical spine it was 10.5° ± 8.2° (range −11° to 36°).CONCLUSIONSAn absolute measurement of the angle between C-2 and C-7 does not unequivocally define the sagittal cervical alignment. As can be seen from the minimum and maximum values, even a positive angle between C-2 and C-7 could be present in a kyphotic spine. For this purpose, the modified Toyama method (drawing a line from the posterior inferior part of the vertebral body of C-2 to the posterior upper part of the vertebral body of C-7 without any measurements) is a better tool for a global assessment of cervical sagittal alignment.Clinical trial registration no.: ISRCTN41681847 (https://www.isrctn.com)

scholarly journals Relationship between the atlantodental interval and T1 slope after atlantoaxial fusion in patients with rheumatoid arthritis

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Byeong Jin Ha ◽  
Yu Deok Won ◽  
Je Il Ryu ◽  
Myung-Hoon Han ◽  
Jin Hwan Cheong ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Sagittal Alignment ◽  
Multivariate Logistic Regression Analysis ◽  
Atlantoaxial Instability ◽  
Atlantoaxial Fusion ◽  
T1 Slope ◽  
Significant Difference ◽  
Cervical Sagittal Alignment ◽  
Before And After ◽  
Atlantodental Interval

Abstract Background Atlantoaxial fusion has been widely used for the treatment of atlantoaxial instability (AAI). However, atlantoaxial fusion sacrifices the motion of atlantoaxial articulation, and postoperative loss of cervical lordosis and aggravation of cervical kyphosis are observed. We investigated various factors under the hypothesis that the atlantodental interval (ADI) and T1 slope may be associated with sagittal alignment after atlantoaxial fusion in patients with rheumatoid arthritis (RA). Methods We retrospectively investigated 64 patients with RA who underwent atlantoaxial fusion due to AAI. Radiological factors, including the ADI, T1 slope, Oc-C2 angle, cervical sagittal vertical axis, and C2–C7 angle, were measured before and after surgery. Results The various factors associated with atlantoaxial fusion before and after surgery were compared according to the upper and lower preoperative ADIs. There was a significant difference in the T1 slope 1 year after surgery (p = 0.044) among the patients with lower preoperative ADI values. The multivariate logistic regression analysis showed that the preoperative ADI (> 7.92 mm) defined in the receiver-operating characteristic curve analysis was an independent predictive factor for the increase in the T1 slope 1 year after atlantoaxial fusion (odds ratio, 4.59; 95% confidence interval, 1.34–15.73; p = 0.015). Conclusion We found an association between the preoperative ADI and difference in the T1 slope after atlantoaxial fusion in the patients with RA. A preoperative ADI (> 7.92 mm) was an independent predictor for the increase in the T1 slope after atlantoaxial fusion. Therefore, performing surgical treatment when the ADI is low would lead to better cervical sagittal alignment.

Does Cervical Sagittal Alignment Correlate with Outcomes following Anterior Cervical Surgery?

2015 ◽  
Vol 15 (10) ◽  
pp. S242-S243
Author(s):  
John A. Sielatycki ◽  
Sheyan J. Armaghani ◽  
Arnold Silverberg ◽  
Matthew J. McGirt ◽  
Clinton J. Devin ◽  
...  
Keyword(s):  
Sagittal Alignment ◽  
Cervical Surgery ◽  
Cervical Sagittal Alignment ◽  
Anterior Cervical Surgery

scholarly journals Sagittal balance of the cervical spine: an analysis of occipitocervical and spinopelvic interdependence, with C-7 slope as a marker of cervical and spinopelvic alignment

2015 ◽  
Vol 23 (1) ◽  
pp. 16-23 ◽  
Author(s):  
Susan Núñez-Pereira ◽  
Wolfgang Hitzl ◽  
Viola Bullmann ◽  
Oliver Meier ◽  
Heiko Koller
Keyword(s):  
Cervical Spine ◽  
Sagittal Alignment ◽  
Thoracolumbar Spine ◽  
Sacral Slope ◽  
Horizontal Line ◽  
Lower Cervical Spine ◽  
Compensatory Mechanisms ◽  
Spinopelvic Alignment ◽  
Asymptomatic Patients ◽  
Cervical Sagittal Alignment

OBJECT Sagittal malalignment of the cervical spine has been associated with worsened postsurgical outcomes. For better operative planning of fusion and alignment restoration, improved knowledge of ideal fusion angles and interdependences between upper and lower cervical spine alignment is needed. Because spinal and spinopelvic parameters might play a role in cervical sagittal alignment, their associations should be studied in depth. METHODS The authors retrospectively analyzed digital lateral standing cervical radiographs of 145 patients (34 asymptomatic, 74 symptomatic; 37 surgically treated), including full-standing radiographs obtained in 45 of these patients. Sagittal measurements were as follows: C2–7, occiput (Oc)–C2, C1–2 Cobb angles, and C-7 slope (the angle between the horizontal line and the superior endplate of C-7), as well as T4–12 and L1–S1 Cobb angles, sacral slope, pelvic incidence, and C-7 sagittal vertical axis (SVA). A correlation analysis was performed, and linear regression models were developed. RESULTS Statistical analyses revealed significant correlations between C2–7 and Oc–C2 (r = −0.4, p < 0.01), Oc–C2 (r = −0.3, p < 0.01), and C1–2 angle (r = −0.3, p < 0.01). C-7 slope was significantly correlated with C2–7 (r = −0.5, p < 0.01) and with Oc–C2 angle (r = 0.2, p = 0.02). Total cervical (Oc–C7) lordosis was 30.2° and did not differ significantly among asymptomatic, symptomatic, and surgically treated patients. Correlations between C2–7 and Oc–C2 alignment were stronger in asymptomatic patients (r = –0.5, p < 0.01) and surgically treated patients (r = –0.5, p < 0.01) than in symptomatic patients (r = –0.3, p = 0.01), but the between-group difference was not significant (p > 0.1). Comparing cervical and spinopelvic alignment revealed a significant correlation between sacral slope and C-7 slope (r = –0.3, p = 0.04) and C2–7 (r = 0.4, p < 0.01). The C-7 SVA correlated significantly with the C-7 slope (r = –0.4, p < 0.01). The interdependences were stronger within the occipitocervical parameters than between the cervical and remaining spinal parameters. CONCLUSIONS Significant correlations between the upper and lower cervical spine exist, confirming the existence of inherent compensatory mechanisms to maintain overall balance; no significant differences were found among asymptomatic, symptomatic, and surgically treated patients. The C-7 slope is a useful marker of overall sagittal alignment, acting as a link between the occipitocervical and thoracolumbar spine.

scholarly journals Relationship of T1 Slope with sagittal alignment parameters of the upper and subaxial cervical spine in patients with cervical lordotic and kyphotic curvature

2020 ◽  
Author(s):  
Dong Sun ◽  
Peng Liu ◽  
Zhaolin Wang ◽  
Jie Cheng ◽  
Jianhui Mou ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Sagittal Alignment ◽  
Pearson Correlation ◽  
Linear Regression Analysis ◽  
Observer Agreement ◽  
Group Differences ◽  
Cervical Lordosis ◽  
Cervical Alignment ◽  
T1 Slope ◽  
Subaxial Cervical Spine

Abstract Background: To identify the relationship between T1 slope and the sagittal alignment parameters of the upper and subaxial cervical spine in patients with cervical lordosis and kyphosis.Methods: Relevant sagittal radiographic parameters pertaining to patients with non-specific neck pain but with no associated neurogenic symptoms were retrospectively analyzed. Patients were categorized into lordotic alignment and kyphotic alignment groups based on the C2-C7 Cobb. Correlation among radiographic variables was assessed with the Pearson correlation coefficient and linear regression analysis. Between-group differences with respect to cervical alignment parameters were assessed with One-way Analysis of Variance.Results: Intra-observer and inter-observer agreement (two independent observers) was rated as excellent (kappa: 0.91 - 0.93). Inter-observer agreement for the two independent observers was rated as and substantial (kappa: 0.79 - 0.80), respectively. Significant between-group differences were observed with respect to C0-C1 angle, C1-C2 angle, C0-C2 angle, C2-C7 SVA (sagittal vertical axis) and TS-CL (T1 slope minus cervical lordosis) (P<0.01 for all), but not with respect to T1S (T1 slope) (P=0.367). In both groups, C2-C7 SVA showed a significant linear correlation with T1S (r2=0.712 vs. r2=0.467) and TS-CL (r2=0.810 vs. r2=0.248).Conclusion: This study showed that the two cervical alignment types (lordosis and kyphosis) have different angular variation in upper and subaxial cervical spine. With the increase in T1 slope, the upper cervical C0-C2 Cobb angle and the C2-7 SVA in the lordotic group were significantly higher than that of the kyphotic group. TS-CL mismatch may significantly impact lordotic cervical alignment in patients with lordosis.

scholarly journals How the neck affects the back: changes in regional cervical sagittal alignment correlate to HRQOL improvement in adult thoracolumbar deformity patients at 2-year follow-up

2015 ◽  
Vol 23 (2) ◽  
pp. 153-158 ◽  
Author(s):  
Themistocles S. Protopsaltis ◽  
Justin K. Scheer ◽  
Jamie S. Terran ◽  
Justin S. Smith ◽  
D. Kojo Hamilton ◽  
...  
Keyword(s):  
Correlation Analysis ◽  
Partial Correlation ◽  
Sagittal Alignment ◽  
Patient Questionnaire ◽  
Partial Correlation Analysis ◽  
Cervical Alignment ◽  
Cervical Sagittal Alignment ◽  
Sagittal Parameters ◽  
Clinical Measures

OBJECT Regional cervical sagittal alignment (C2–7 sagittal vertical axis [SVA]) has been shown to correlate with health-related quality of life (HRQOL). The study objective was to examine the relationship between cervical and thoracolumbar alignment parameters with HRQOL among patients with operative and nonoperative adult thoracolumbar deformity. METHODS This is a multicenter prospective data collection of consecutive patients with adult thoracolumbar spinal deformity. Clinical measures of disability included the Oswestry Disability Index (ODI), Scoliosis Research Society-22 Patient Questionnaire (SRS-22), and 36-Item Short-Form Health Survey (SF-36). Cervical radiographic parameters were correlated with global sagittal parameters within the nonoperative and operative cohorts. A partial correlation analysis was performed controlling for C-7 SVA. The operative group was subanalyzed by the magnitude of global deformity (C-7 SVA ≥ 5 cm vs < 5 cm). RESULTS A total of 318 patients were included (186 operative and 132 nonoperative). The mean age was 55.4 ± 14.9 years. Operative patients had significantly worse baseline HRQOL and significantly larger C-7 SVA, pelvic tilt (PT), mismatch between pelvic incidence and lumbar lordosis (PI-LL), and C2-7 SVA. The operative patients with baseline C-7 SVA ≥ 5 cm had significantly larger C2-7 lordosis (CL), C2-7 SVA, C-7 SVA, PI-LL, and PT than patients with a normal C-7 SVA. For all patients, baseline C2-7 SVA and CL significantly correlated with baseline ODI, Physical Component Summary (PCS), SRS Activity domain, and SRS Appearance domain. Baseline C2-7 SVA also correlated with SRS Pain and SRS Total. For the operative patients with baseline C-7 SVA ≥ 5 cm, the 2-year C2-7 SVA significantly correlated with 2-year Mental Component Summary, SRS Mental, SRS Satisfaction, and decreases in ODI. Decreases in C2-7 SVA at 2 years significantly correlated with lower ODI at 2 years. Using partial correlations while controlling for C-7 SVA, the C2-7 SVA correlated significantly with baseline ODI (r = 0.211, p = 0.002), PCS (r = −0.178, p = 0.009), and SRS Activity (r = −0.145, p = 0.034) for the entire cohort. In the subset of operative patients with larger thoracolumbar deformities, the change in C2-7 SVA correlated with change in ODI (r = −0.311, p = 0.03). CONCLUSIONS Changes in cervical lordosis correlate to HRQOL improvements in thoracolumbar deformity patients at 2-year follow-up. Regional cervical sagittal parameters such as CL and C2–7 SVA are correlated with clinical measures of regional disability and health status in patients with adult thoracolumbar scoliosis. This effect may be direct or a reciprocal effect of the underlying global deformities on regional cervical alignment. However, the partial correlation analysis, controlling for the magnitude of the thoracolumbar deformity, suggests that there is a direct effect of cervical alignment on health measures. Improvements in regional cervical alignment postoperatively correlated positively with improved HRQOL.

scholarly journals Use of Bivector Traction for Stabilization of the Head and Maintenance of Optimal Cervical Alignment in Posterior Cervical Fusions

2017 ◽  
Vol 7 (3) ◽  
pp. 227-229 ◽  
Author(s):  
Isaac O. Karikari ◽  
David B. Bumpass ◽  
Jeffrey Gum ◽  
Patrick Sugrue ◽  
Todd M. Chapman ◽  
...  
Keyword(s):  
Sagittal Alignment ◽  
Intraoperative Complications ◽  
Demographic Data ◽  
Case Series ◽  
Cervical Lordosis ◽  
Consecutive Case ◽  
Vertical Alignment ◽  
Cervical Sagittal Alignment ◽  
Novel Method ◽  
The Mean

Study Design: Retrospective analysis of consecutive case series. Objective: To introduce a novel method of stabilizing the cranium using bivector traction in posterior cervical fusions. Methods: A retrospective review of 50 consecutive patients undergoing instrumented posterior cervical arthrodesis was performed. All patients had at least 3 levels of subaxial fusion using the bivector traction apparatus. Patients’ demographic data was recorded for the following: pre- and postoperative cervical lordosis, pre- and postoperative cervical sagittal vertical alignment (cSVA), and intraoperative complications from pin placements. Results: A total of 50 patients were studied. There were 31 females and 19 males. The mean age at the time of surgery was 49 years (range 35-79). A mean 5.8 levels were fused. The most common levels fused were C2-T3 in 14 patients followed by C2-T2 in 7 patients. In no case did the surgeon or assistant have to scrub out to adjust the alignment. The mean pre- and postoperative cervical lordosis was −6.0° and −10°, respectively ( P = .04). The mean pre-and postoperative cSVA was 30.5 mm and 32 mm, respectively ( P = .6). There were no complications related to placement of the Gardner-Well tongs. Conclusion: The bivector traction is an easy, safe, and effective method of stabilizing the head and obtaining adequate cervical sagittal alignment.

scholarly journals Relationship between the atlantodental interval and T1 slope after atlantoaxial fusion in patients with rheumatoid arthritis

2020 ◽  
Author(s):  
Byeong Jin Ha ◽  
Yu Deok Won ◽  
Jeil Ryu ◽  
Myung-Hoon Han ◽  
Jin Hwan Cheong ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Sagittal Alignment ◽  
Multivariate Logistic Regression Analysis ◽  
Atlantoaxial Instability ◽  
Atlantoaxial Fusion ◽  
T1 Slope ◽  
Significant Difference ◽  
Cervical Sagittal Alignment ◽  
Before And After ◽  
Atlantodental Interval

Abstract Background Atlantoaxial fusion has been widely used for the treatment of atlantoaxial instability (AAI). However, atlantoaxial fusion sacrifices the motion of atlantoaxial articulation, and postoperative loss of cervical lordosis and aggravation of cervical kyphosis are observed. We investigated various factors under the hypothesis that the atlantodental interval (ADI) and T1 slope may be associated with sagittal alignment after atlantoaxial fusion in patients with rheumatoid arthritis (RA). Methods We retrospectively investigated 64 patients with RA who underwent atlantoaxial fusion due to AAI. Radiological factors, including the ADI, T1 slope, Oc-C2 angle, cervical sagittal vertical axis, and C2-C7 angle, were measured before and after surgery. Results The various factors associated with atlantoaxial fusion before and after surgery were compared according to the upper and lower preoperative ADIs. There was a significant difference in the T1 slope 1 year after surgery (p = 0.044) among the patients with lower preoperative ADI values. The multivariate logistic regression analysis showed that the preoperative ADI (> 7.92 mm) defined in the receiver-operating characteristic curve analysis was an independent predictive factor for the increase in the T1 slope 1 year after atlantoaxial fusion (odds ratio, 4.66; 95% confidence interval, 1.37–15.84; p = 0.014). Conclusion We found an association between the preoperative ADI and difference in the T1 slope after atlantoaxial fusion in the patients with RA. A preoperative ADI (> 7.92 mm) was an independent predictor for the increase in the T1 slope after atlantoaxial fusion. Therefore, performing surgical treatment when the ADI is low would lead to better cervical sagittal alignment.

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