scholarly journals The Effect of Cervical Fusion on Functional Sagittal Spinal Alignment Based on the Inflection Point: Case Series Study

2021 ◽  
pp. 219256822110017
Author(s):  
Moon Soo Park ◽  
Seong-Hwan Moon ◽  
Young-Woo Kim ◽  
Jin Kyu Lim ◽  
Jong Ho Jung ◽  
...  
Keyword(s):  
Inflection Point ◽  
Sagittal Alignment ◽  
Cervical Fusion ◽  
Cervical Lordosis ◽  
Fusion Surgery ◽  
Inflection Points ◽  
Sagittal Spinal Alignment ◽  
Cervical Segment ◽  
Sagittal Parameters ◽  
Level Fusion

Study Design: A retrospective radiologic study. Objective: The inflection point is the disc space between a lordotic and kyphotic segment of spine. To our knowledge, there has been no study evaluating changes in functional sagittal alignment determined by inflection points after cervical fusion surgery. The purpose is to identify changes in functional sagittal alignment after cervical fusion as determined by functional segments between cervicothoracic and thoracolumbar inflection points. Methods: Standing radiographs of the sagittal whole spine were taken in 62 patients who underwent cervical fusion procedures. We identified cervicothoracic and thoracolumbar inflection points in the sagittal plane and measured Cobb angles of resulting “functional” cervical, thoracic, and lumbar segments. We also measured the C2 and T1 sagittal vertical axis (SVA) distance to S1 and the anatomic cervical lordosis, thoracic kyphosis, lumbar lordosis, spinopelvic parameters, and T1 sagittal slope. We compared the pre- and post-op values. Results: The functional cervical segment and T1 sagittal slope increased postoperatively. C2 and T1 SVA distance to S1 decreased postoperatively. In patients with a single level fusion or lower instrumented vertebra (LIV) proximal or equal to C6, functional cervical segment, and anatomic cervical lordosis increased postoperatively. In those with multiple level fusion or LIV distal or equal to C7, the C2 SVA distance to S1 decreased postoperatively. Conclusions: After cervical fusion surgery, functional cervical sagittal parameters determined by the inflection point improve without changes in the anatomic sagittal parameters. Postoperative changes in functional sagittal parameters were affected by the number of fused levels and LIV.

Relationship Between Cervical Sagittal Alignment and Patient Outcomes After Anterior Cervical Fusion Surgery Involving 3 or More Levels

2018 ◽  
Vol 113 ◽  
pp. e548-e554 ◽  
Author(s):  
Se-Il Jeon ◽  
Seung-Jae Hyun ◽  
Sanghyun Han ◽  
Byoung Hun Lee ◽  
Ki-Jeong Kim ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Sagittal Alignment ◽  
Anterior Cervical Fusion ◽  
Cervical Fusion ◽  
Fusion Surgery ◽  
Cervical Sagittal Alignment

scholarly journals Sagittal alignment based on inflection point and its differences according to age groups

2020 ◽  
Vol 28 (1) ◽  
pp. 230949902090461
Author(s):  
Moon Soo Park ◽  
Seong-Hwan Moon ◽  
Tae-Hwan Kim ◽  
Jae Keun Oh ◽  
Seung Jin Lee ◽  
...  
Keyword(s):  
Pelvic Incidence ◽  
Sagittal Plane ◽  
Sagittal Alignment ◽  
Age Groups ◽  
Vertical Axis ◽  
Sacral Slope ◽  
Sagittal Vertical Axis ◽  
Inflection Points ◽  
Lumbar Segment ◽  
Cervical Segment

Purpose: We have always used the standard anatomical landmark vertebrae to measure the sagittal alignment. Instead, scoliosis has been evaluated by the end vertebrae in the coronal plane. There have been clinical studies to investigate sagittal alignment on the end vertebrae of inflection points (IPs). The purpose is to determine sagittal alignment based on IPs and to elucidate the changes while considering age groups. Methods: We identified the most titled vertebrae in the sagittal plane to define the end vertebrae of S1, thoracolumbar and cervicothoracic IPs and to measure the Cobb angles of sacral slope, functional lumbar, thoracic, cervical segment between them, and the McGregor’s line, and the IP distances from the C2 plumb line to the point bisecting the upper end plate of the IPs, in addition to S1. Results: The most common thoracolumbar and cervicothoracic IPs were L2 and T1, respectively. However, the next most common cervicothoracic IP changed from T2 in the youngest to C7 in the oldest age group. The sagittal angles decreased at the sacral slope and functional lumbar segment but not the functional thoracic segment and functional cervical segment. Similarly, the distance increased at the C2 sagittal vertical axis (SVA) distance to S1 and thoracolumbar IP distance but not at the cervicothoracic IP distance. There was no difference in the pelvic incidence among age groups. Conclusion: The sagittal Cobb angles based on the IPs decreased at the sacral slope and functional lumbar segment in the older adults. Consequently, the C2 SVA distance to S1 and thoracolumbar IP distance increased.

The Impact of Standing Regional Cervical Sagittal Alignment on Outcomes in Posterior Cervical Fusion Surgery

2012 ◽  
Vol 12 (9) ◽  
pp. S65 ◽  
Author(s):  
Jessica A. Tang ◽  
Justin K. Scheer ◽  
Justin S. Smith ◽  
Vedat Deviren ◽  
R. Shay Bess ◽  
...  
Keyword(s):  
Sagittal Alignment ◽  
Cervical Fusion ◽  
Fusion Surgery ◽  
Cervical Sagittal Alignment ◽  
Posterior Cervical Fusion ◽  
The Impact

Clinical Impact of T1 Slope Minus Cervical Lordosis After Multilevel Posterior Cervical Fusion Surgery

Spine ◽  
2017 ◽  
Vol 42 (24) ◽  
pp. 1859-1864 ◽  
Author(s):  
Seung-Jae Hyun ◽  
Ki-Jeong Kim ◽  
Tae-Ahn Jahng ◽  
Hyun-Jib Kim
Keyword(s):  
Clinical Impact ◽  
Cervical Fusion ◽  
Cervical Lordosis ◽  
Fusion Surgery ◽  
T1 Slope ◽  
Posterior Cervical Fusion

scholarly journals The Pelvic Incidence Stratified Sagittal Spinopelvic Alignment in Asymptomatic Chinese Population With Different Age Groups

2021 ◽  
pp. 219256822198964
Author(s):  
Siyu Zhou ◽  
Zhuoran Sun ◽  
Wei Li ◽  
Da Zou ◽  
Weishi Li
Keyword(s):  
Chinese Population ◽  
Pelvic Incidence ◽  
Sagittal Alignment ◽  
Age Groups ◽  
Vertical Axis ◽  
Elderly Subjects ◽  
Sagittal Vertical Axis ◽  
Cross Sectional ◽  
Sagittal Parameters ◽  
Very High

Study Design: Cross-sectional study. Objective: To provide the age- and pelvic incidence-related variations of sagittal alignment in asymptomatic Chinese population. Methods: This study recruited asymptomatic adult subjects. All subjects undertook the standing whole spinal radiograph and the sagittal parameters were measured: sagittal vertical axis (SVA), T1 pelvic angle (TPA), lumbar lordosis (LL), thoracic kyphosis (TK), pelvic incidence (PI) and pelvic tilt (PT). All subjects were divided into young, middle aged and elderly groups, then each age group was further divided into 5 subgroups (very low, low, average, high and very high) based on PI values. The relations between PI, age and other parameters were evaluated. The differences in sagittal parameters of each PI subgroup were compared. Results: 546 subjects were included with an average age of 38.6 years (18 to 81). The number of subjects over 70 years and with very low PI was relatively small. The average of PI, TPA, PT and LL were 45.9° ± 8.4°, 6.4° ± 6.2°, 11.9° ± 6.6° and 49.2° ± 10.1°, respectively. SVA, TPA, TK and PT increased with age ( P < 0.05), while SVA, TPA, PT, PI-LL also increased with PI ( P < 0.05). LL, PT, TPA, PI-LL and LL-TK were different among the 5 PI subgroups ( P < 0.05). However, the values of LL in elderly subjects with high and very high PI were similar. Conclusion: The age- and PI-related variations in sagittal alignment of Chinese population were provided. The sagittal parameters were significantly influenced by age and PI. The individual pelvic morphology should be carefully considered during the assessment and restoration of sagittal balance.

scholarly journals Specific sagittal alignment patterns are already present in mild adolescent idiopathic scoliosis

2021 ◽  
Author(s):  
Tom P. C. Schlösser ◽  
René M. Castelein ◽  
Pierre Grobost ◽  
Suken A. Shah ◽  
Kariman Abelin-Genevois
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Inflection Point ◽  
Thoracic Kyphosis ◽  
Sagittal Alignment ◽  
Three Dimensional ◽  
Sagittal Profile ◽  
Thoracolumbar Kyphosis ◽  
C7 Slope ◽  
Sagittal Malalignment

Abstract Purpose The complex three-dimensional spinal deformity in AIS consists of rotated, lordotic apical areas and neutral junctional zones that modify the spine’s sagittal profile. Recently, three specific patterns of thoracic sagittal ‘malalignment’ were described for severe AIS. The aim of this study is to define whether specific patterns of pathological sagittal alignment are already present in mild AIS. Methods Lateral spinal radiographs of 192 mild (10°–20°) and 253 severe (> 45°) AIS patients and 156 controls were derived from an international consortium. Kyphosis characteristics (T4–T12 thoracic kyphosis, T10–L2 angle, C7 slope, location of the apex of kyphosis and of the inflection point) and sagittal curve types according to Abelin-Genevois were systematically compared between the three cohorts. Results Even in mild thoracic AIS, already 49% of the curves presented sagittal malalignment, mostly thoracic hypokyphosis, whereas only 13% of the (thoraco) lumbar curves and 6% of the nonscoliosis adolescents were hypokyphotic. In severe AIS, 63% had a sagittal malalignment. Hypokyphosis + thoracolumbar kyphosis occurred more frequently in high-PI and primary lumbar curves, whereas cervicothoracic kyphosis occurred more in double thoracic curves. Conclusions Pathological sagittal patterns are often already present in curves 10°–20°, whereas those are rare in non-scoliotic adolescents. This suggests that sagittal ‘malalignment’ patterns are an integral part of the early pathogenesis of AIS.

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