Cervical sagittal alignment in patients with dropped head syndrome

Background: Dropped head syndrome (DHS) can be divided into two types, the positive sagittal vertical axis (SVA) type and the negative SVA type. However, the cervical sagittal alignment of DHS including global sagittal spinal alignment and the typical cervical alignment of the types of DHS is still unclear. The purpose of this study was to clarify the character of cervical sagittal alignment of DHS and analyze the relationship between cervical sagittal alignment and global sagittal spinal alignment. Methods: The subjects were 35 DHS patients (10 men, 25 women, mean 71.1 years old). They were divided into two groups: negative DHS (N-DHS group, SVA < 0 mm) and positive DHS group (P-DHS group, SVA ≥ 0 mm). As control, 28 age-matched cervical spondylosis patients (CS, 21 men, 7 women, mean 67.4 years old) were analyzed. The following parameters were measured on lateral global-spine standing radiographs: cervical SVA (C2-C7SVA), O-C2A (O-C2 angle), C2 slope (C2S), C2-7A (C2-7 angle), T1 slope (T1S) and C7SVA. Results: The results of measurements of each of the averaged sagittal alignment parameters were (CS, P-DHS, N-DHS): C2-7SVA(26.2 mm, 47.3 mm, 44.5 mm), O-C2 angle (35.0°, 37.1°, 39.3°), C2S (16.5°, 31.4°, 33.8°), C2-7A (9.3°, 9.9°, −16.6°), T1S (22.9°, 39.7°, 25.7°), C7SVA (35.3 mm, 51.0 mm, −43.1 mm). C2-C7SVA and C2S were significantly larger in both types of DHS compared to CS. Comparing P-DHS with N-DHS, C2-C7A and T1S were significantly smaller in N-DHS. Conclusions: O-C2A did not differ significantly among CS, P-DHS and N-DHS. In DHS patients, C2-7SVA and C2S were significantly larger than those of CS regardless of the type of DHS. The typical cervical sagittal alignment of DHS was different between P-DHS and N-DHS. In P-DHS, C2-7A and T1S were larger than those in N-DHS and the imbalance of thoraco-lumbar alignment should be noted.

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Global sagittal spinal alignment at cervical flexion in patients with dropped head syndrome

Journal of Orthopaedic Surgery ◽

10.1177/2309499020948266 ◽

2020 ◽

Vol 28 (3) ◽

pp. 230949902094826 ◽

Cited By ~ 1

Author(s):

Takamitsu Konishi ◽

Kenji Endo ◽

Takato Aihara ◽

Hidekazu Suzuki ◽

Yuji Matsuoka ◽

...

Keyword(s):

Thoracic Spine ◽

Vertical Axis ◽

Control Group ◽

Sacral Slope ◽

Neutral Position ◽

Spinal Alignment ◽

Sagittal Vertical Axis ◽

Dropped Head Syndrome ◽

Sagittal Spinal Alignment ◽

Significant Difference

Purpose: Dropped head syndrome (DHS) is characterized by the passively correctable chin-on-chest deformity. The characteristic feature is emphasized in the cervical flexion position. The purpose of this study was to analyze the influence of cervical flexion on sagittal spinal alignment in patients with DHS. Methods: The study included 15 DHS subjects and 55 cervical spondylosis (CS) subjects as the control group. The following parameters were analyzed: cervical sagittal vertical axis (C-SVA), occipitoaxial angle (O–C2A), C2 slope (C2S), C2–C7 angle (C2–C7A), T1 slope (T1S), sagittal vertical axis, T1–T4 angle (T1–T4A), T5–T8 angle (T5–T8A), T9–T12 angle, lumbar lordosis, sacral slope, and pelvic tilt, in cervical flexion and neutral positions. Results: The values of C-SVA, O–C2A, C2S, and T1S were significantly different between CS and DHS at cervical neutral and flexion positions. C2–C7A showed significant difference in cervical neutral position, but the difference disappeared in flexion position. T1–T4A did not present a significant difference, but T5–T8A showed a difference in neutral and flexion positions. Conclusions: Malalignment of DHS extended not only to cervical spine but also to cranio-cervical junction and thoracic spine, except T1–T4. It is known that global sagittal spinal alignment is correlated with adjacent parameters, although in DHS the reciprocal change was lost from cranio-cervical junction to the middle part of thoracic spine at cervical flexion.

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The Influence of Natural Head Position on the Cervical Sagittal Alignment

Journal of Healthcare Engineering ◽

10.1155/2017/2941048 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7

Author(s):

Kuan Wang ◽

Zhen Deng ◽

Zhengyan Li ◽

Huihao Wang ◽

Hongsheng Zhan

Keyword(s):

Cervical Spine ◽

Sagittal Alignment ◽

Vertical Axis ◽

Head Position ◽

Biomechanical Analysis ◽

Sagittal Vertical Axis ◽

Cervical Sagittal Alignment ◽

Backward Shift ◽

The Relationship ◽

Curvature Type

Introduction. This study investigated the relationship between the parameters related to the natural head position and cervical segmental angles and alignment of patients with neck pain. Material and Methods. The lateral radiographs of the cervical spine were collected from 103 patients and were used to retrospectively analyze the correlation between the natural head position, cervical local sagittal angles, and alignment. Sagittal measurements were as follows: cervical curvature classification, slope of McGregor’s line (McGS), local sagittal angles (C0–C2 angle, C2–C5 angle, C5–C7 angle, and C2–C7 angle), T1 slope, center of gravity of the head to sagittal vertical axis (CG–C7 SVA), and local sagittal alignment (C0–C2 SVA and C2–C7 SVA). Results. McGS was significantly correlated to C0–C2 angle (r=0.57), C0–C2 SVA (r=−0.53), C2–C7 SVA (r=−0.28), and CG–C7 SVA (r=−0.47). CG–C7 SVA was also significantly correlated to curvature type (r=0.27), C5–C7 angle (r=−0.37), and C2–C7 angle (r=−0.39). Conclusions. A backward shift with an extended head position may accompany a relatively normal curvature of the cervical spine. The effect of posture control in relieving abnormal mechanical state of the cervical spine needs to be further confirmed by biomechanical analysis.

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Cervical Spinal Alignment Change Accompanying Spondylosis Exposes Harmonization Failure with Total Spinal Balance: A Japanese Cohort Survey Randomly Sampled from a Basic Resident Registry

Journal of Clinical Medicine ◽

10.3390/jcm10245737 ◽

2021 ◽

Vol 10 (24) ◽

pp. 5737

Author(s):

Shota Ikegami ◽

Masashi Uehara ◽

Ryosuke Tokida ◽

Hikaru Nishimura ◽

Noriko Sakai ◽

...

Keyword(s):

Cervical Spondylosis ◽

Vertical Axis ◽

Standing Position ◽

Community Dwelling ◽

Spinal Alignment ◽

Sagittal Vertical Axis ◽

Japanese Cohort ◽

Sagittal Spinal Alignment ◽

Cervical Spinal Alignment ◽

Whole Spine

The relationship between spinal posture and quality of life has garnered considerable attention with the increase in older community-dwelling residents. However, details of this association remain insufficient. A recent Japanese population cohort epidemiological locomotion survey (the Obuse study) revealed that the C2–C7 cervical sagittal vertical axis (CSVA) began to increase in males from their 60s, but not in females. This study aimed to clarify the pathology of these cervical spondylotic changes. A total of 411 participants (202 male and 209 female) aged between 50 and 89 years were selected by random sampling from a cooperating town’s resident registry. All participants underwent lateral X-ray photography in a standing position for the measurement of several sagittal spinal alignment parameters, including CSVA, C2–C7 cervical lordosis (CL), T1 slope (T1S), and sagittal vertical axis (SVA). The presence of cervical spondylotic changes was also recorded. Associations of cervical sagittal spinal alignment with cervical spondylosis and between cervical and total sagittal spinal alignment were examined. The prevalence of cervical spondylosis was significantly higher in males (81%) than in females (70%) (p = 0.01). CL was significantly smaller in cervical spondylosis subjects when adjusted by age (3.4 degrees less; p = 0.01). T1S minus CL displayed a moderate positive correlation with CSVA in both males and females (r = 0.49 and 0.48, respectively, both p < 0.01). In males only, CSVA and CL showed weak positive correlations with SVA (r = 0.31 and 0.22, respectively, both p < 0.01) independently of age. Cervical spinal misalignment was more clearly associated with diminished SF-8TM scores in females than in males. In community-dwelling elderly residents, cervical sagittal spinal alignment change accompanying cervical spondylosis manifested as hypofunction to compensate for whole-spine imbalance.

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Global Spinal Alignment in Cervical Kyphotic Deformity: The Importance of Head Position and Thoracolumbar Alignment in the Compensatory Mechanism

Neurosurgery ◽

10.1093/neuros/nyx288 ◽

2017 ◽

Vol 82 (5) ◽

pp. 686-694 ◽

Cited By ~ 17

Author(s):

Jun Mizutani ◽

Kushagra Verma ◽

Kenji Endo ◽

Ken Ishii ◽

Kuniyoshi Abumi ◽

...

Keyword(s):

Vertical Axis ◽

Head Position ◽

Compensatory Mechanism ◽

Spinal Alignment ◽

Cervical Kyphosis ◽

Compensatory Mechanisms ◽

Sagittal Vertical Axis ◽

Lumbar Degeneration ◽

The Relationship ◽

Retrospective Multicenter Study

Abstract BACKGROUND Previous studies have evaluated cervical kyphosis (C-kypho) using cervical curvature or chin-brow vertical angle, but the relationship between C-kypho and global spinal alignment is currently unknown. OBJECTIVE To elucidate global spinal alignment and compensatory mechanisms in primary symptomatic C-kypho using full-spine radiography. METHODS In this retrospective multicenter study, symptomatic primary C-kypho patients (Cerv group; n = 103) and adult thoracolumbar deformity patients (TL group; n = 119) were compared. We subanalyzed Cerv subgroups according to sagittal vertical axis (SVA) values of C7 (SVAC7 positive or negative [C7P or C7N]). Various Cobb angles (°) and SVAs (mm) were evaluated. RESULTS SVAC7 values were –20.2 and 63.6 mm in the Cerv group and TL group, respectively (P < .0001). Various statistically significant compensatory curvatures were observed in the Cerv group, namely larger lumbar lordosis (LL) and thoracic kyphosis. The C7N group had significantly lower SVACOG (center of gravity of the head) and SVAC7 (32.9 and –49.5 mm) values than the C7P group (115.9 and 45.1 mm). Sagittal curvatures were also different in T4-12, T10-L2, LL4-S, and LL. The value of pelvic incidence (PI)-LL was different (C7N vs C7P; –2.2° vs 9.9°; P < .0003). Compensatory sagittal curvatures were associated with potential for shifting of SVAC7 posteriorly to adjust head position. PI-LL affected these compensatory mechanisms. CONCLUSION Compensation in symptomatic primary C-kypho was via posterior shifting of SVAC7, small T1 slope, and large LL. However, even in C-kypho patients, lumbar degeneration might affect global spinal alignment. Thus, global spinal alignment with cervical kyphosis is characterized as head balanced or trunk balanced.

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Small sagittal vertical axis accompanied with lumbar hyperlordosis as a risk factor for developing postoperative cervical kyphosis after expansive open-door laminoplasty

Journal of Neurosurgery Spine ◽

10.3171/2017.12.spine17557 ◽

2018 ◽

Vol 29 (2) ◽

pp. 176-181 ◽

Cited By ~ 3

Author(s):

Yuji Matsuoka ◽

Hidekazu Suzuki ◽

Kenji Endo ◽

Yasunobu Sawaji ◽

Kazuma Murata ◽

...

Keyword(s):

Vertical Axis ◽

Sagittal Imbalance ◽

Open Door ◽

Spinal Alignment ◽

Cervical Kyphosis ◽

Sagittal Vertical Axis ◽

Sagittal Spinal Alignment ◽

Lumbar Hyperlordosis ◽

The Difference ◽

Whole Spine

OBJECTIVEPreoperative positive cervical sagittal imbalance and global sagittal imbalance are risk factors for postoperative cervical kyphosis after expansive open-door cervical laminoplasty (ELAP). The purpose of this study was to investigate the relationship between the incidence of postoperative cervical kyphosis after ELAP and the preoperative global sagittal spinal alignment in patients with cervical spondylotic myelopathy (CSM) without spinal sagittal imbalance.METHODSAmong 84 consecutive patients who underwent ELAP for CSM at the authors’ hospital, 43 patients without preoperative cervical kyphosis (C2–7 angle ≥ 0°) and spinal sagittal imbalance (C2–7 sagittal vertical axis [SVA] ≤ 80 mm and C-7 SVA ≤ 95 mm) were included in the study. The global spinal sagittal parameters were measured on lateral whole-spine standing radiographs preoperatively and at 1 year postoperatively. The difference in preoperative global sagittal spinal alignment between the postoperative cervical lordosis group and the cervical kyphosis group was analyzed.RESULTSThe incidence of postoperative cervical kyphosis after ELAP was 25.6% (11 of 43 cases). Thirty-two patients (16 men and 16 women; mean age 67.7 ± 12.0 years) had lordosis, and 11 (7 men and 4 women; mean age 67.2 ± 9.6 years) had kyphosis. The preoperative C-7 SVA and pelvic incidence minus lumbar lordosis (PI−LL) in the kyphosis group were significantly smaller than those in the lordosis group (p < 0.05). The smaller C-7 SVA accompanied by a small PI−LL, the “truncal negative offset,” led to postoperative cervical kyphosis due to posterior structural weakening by ELAP.CONCLUSIONSIn patients with CSM without preoperative cervical and global spinal sagittal imbalance, a small SVA accompanied by lumbar hyperlordosis is the characteristic alignment leading to postoperative cervical kyphosis after ELAP.

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Uncertainty in the Relationship Between Sagittal Alignment and Patient-Reported Outcomes

Neurosurgery ◽

10.1093/neuros/nyz228 ◽

2019 ◽

Cited By ~ 2

Author(s):

Peter D Angevine ◽

David Bray ◽

Michael Cloney ◽

Hani Malone

Keyword(s):

Patient Reported Outcomes ◽

Sagittal Alignment ◽

Vertical Axis ◽

Senior Author ◽

High Density ◽

Individual Values ◽

Sagittal Vertical Axis ◽

Heterogeneous Effects ◽

Patient Reported ◽

The Relationship

Abstract BACKGROUND Previous studies have reported correlations and precise quantitative relationships between sagittal alignment and health-related quality-of-life (HRQOL) scores. These studies have not reported the extent of uncertainty in these relationships. OBJECTIVE To explore the uncertainty in the overall relationships between sagittal alignment and HRQOL and in the predictions of individual patient pain and disability. METHODS A retrospective analysis of all new adult patients with long-cassette radiographs and complete outcomes questionnaires presenting to the senior author from 2012 to 2014 was performed. Univariable maximum a posteriori linear regression analyses using Bayesian methods were performed. High-density probability intervals for mean regression relationships and for individual values were calculated using minimally informative prior distributions. RESULTS A total of 134 patients satisfied inclusion criteria and were included. For Oswestry Disability Index (ODI) vs pelvic incidence-lumbar lordosis (LL), the 90% high-density probability interval ranged from –0.04 to 0.23, indicating that both the magnitude and direction of the relationship were uncertain. For both ODI vs sagittal vertical axis and ODI vs LL, there was uncertainty in the magnitude of the slope. Wide regions of uncertainty were also seen for predicting individual patient scores. CONCLUSION We report the previously unpublished degree of uncertainty in the mean quantitative relationships between radiographic sagittal alignment and patient-reported outcomes and in individual patient outcomes scores. Based on these results, establishing treatment thresholds or predicting an individual's outcome is unreliable. Further research efforts should be focused on developing multilevel hierarchical models incorporating parameter uncertainty and heterogeneous effects.

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C7 sagittal vertical axis is the determinant of the C5–C7 angle in cervical sagittal alignment

The Spine Journal ◽

10.1016/j.spinee.2016.11.007 ◽

2017 ◽

Vol 17 (5) ◽

pp. 622-626 ◽

Cited By ~ 4

Author(s):

Yoshitaka Matsubayashi ◽

Hirotaka Chikuda ◽

Yasushi Oshima ◽

Yuki Taniguchi ◽

Yoh Fujimoto ◽

...

Keyword(s):

Sagittal Alignment ◽

Vertical Axis ◽

Sagittal Vertical Axis ◽

Cervical Sagittal Alignment

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Impact of spinopelvic alignment on decision making in deformity surgery in adults

Journal of Neurosurgery Spine ◽

10.3171/2012.2.spine11320 ◽

2012 ◽

Vol 16 (6) ◽

pp. 547-564 ◽

Cited By ~ 161

Author(s):

Christopher P. Ames ◽

Justin S. Smith ◽

Justin K. Scheer ◽

Shay Bess ◽

S. Samuel Bederman ◽

...

Keyword(s):

Surgical Planning ◽

Vertical Axis ◽

Spinal Alignment ◽

Spinopelvic Parameters ◽

Sagittal Vertical Axis ◽

Radiographic Findings ◽

Spinopelvic Alignment ◽

Sagittal Spinal Alignment ◽

Cause Of Pain ◽

Proper Analysis

Sagittal spinal misalignment (SSM) is an established cause of pain and disability. Treating physicians must be familiar with the radiographic findings consistent with SSM. Additionally, the restoration or maintenance of physiological sagittal spinal alignment after reconstructive spinal procedures is imperative to achieve good clinical outcomes. The C-7 plumb line (sagittal vertical axis) has traditionally been used to evaluate sagittal spinal alignment; however, recent data indicate that the measurement of spinopelvic parameters provides a more comprehensive assessment of sagittal spinal alignment. In this review the authors describe the proper analysis of spinopelvic alignment for surgical planning. Online videos supplement the text to better illustrate the key concepts.

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Analysis of global spine sagittal parameters in cervical spondylotic patients and asymptomatic subjects

10.21203/rs.2.21726/v1 ◽

2020 ◽

Author(s):

Liang Zhu ◽

Xiaojun Ma ◽

Qiang Shen ◽

Bao Sun ◽

Qiang Fu

Keyword(s):

Cervical Spondylosis ◽

Lumbar Lordosis ◽

Sagittal Alignment ◽

Vertical Axis ◽

Normal Group ◽

Sacral Slope ◽

Sagittal Vertical Axis ◽

Thoracic Inlet ◽

Global Sagittal Alignment ◽

Sagittal Parameters

Abstract Background: Degenerative changes associated with cervical spondylotic can result in a change of normal sagittal alignment, and this may be the initial change of kyphosis and sagittal imbalance. Few studies have analyzed the correlations between the cervical spine lordosis and global spine balance in patients with cervical spondylotic. This study is applied to investigate the characteristics and relationships of cervical and global sagittal parameters in normal adults and cervical spondylotic patients. Methods: We reviewed 46 asymptomatic control subjects (normal group, NG) and 48 cervical spondylotic patients (cervical spondylotic group, CSG), who had both cervical MRI and global radiographs obtained together, between January 2016 and September 2018. Data includes C1-2 angle, C2–7 lordosis (CL), T1 slope (T1S), thoracic inlet angle (TIA), C2–7 sagittal vertical axis (CSVA), sagittal vertical axis(SVA), thoracic-kyphosis(TK), thoracic-lumbar lordosis(TL), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS). The values were presented as the mean ± standard deviation. Student t-test and Pearson’s correlation coefﬁcient were used for statistical analysis. Probability values less than 0.05 were considered statistically signiﬁcant. Results: 1.Comparison of global sagittal parameters between the normal group and cervical spondylosis group. A total of 48 cervical spondylotic patients with an average age of 57.91±9.58 and 46 healthy people with an average age of 28.00±8.09 were recruited in our study. CL in the NG was significantly lower than CSG (P<0.05), while TK and TL were significantly lower than in the CSG(P< 0.01). However, a comparison of the NG and CSG yielded no significant differences in C1-2, TIA, TIS, LL, PT, PI, SS, CSVA, and SVA. 2.The relationship between cervical and global sagittal alignment. CL positively correlated with T1S (r=0.433) and TK (r=0.335) while negatively correlated with CSVA (r=-0.309) in cervical spondylosis group. TIA has positively correlated with T1S (r=0.376 in NG and r=0.416 in CSG) and no correlated with other parameters in both groups. Conclusions Cervical spondylosis causes changes in sagittal parameters of the cervical and thoracic spine but does not affect on lumbar and pelvic parameters. TIA is a relative constant parameter, not affected by cervical spondylotic.

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Relationship of sagittal spinal alignment with low back pain and physical performance in the general population

Scientific Reports ◽

10.1038/s41598-021-00116-w ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Kazuhiro Hira ◽

Keiji Nagata ◽

Hiroshi Hashizume ◽

Yoshiki Asai ◽

Hiroyuki Oka ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Physical Performance ◽

Linear Regression Analysis ◽

Vertical Axis ◽

Low Back ◽

Spinal Alignment ◽

Sagittal Vertical Axis ◽

Sagittal Spinal Alignment ◽

Relationship Of

AbstractStudies have suggested a relationship between sagittal spinal malalignment and low back pain (LBP). The current study investigated the relationship of spinal alignment with LBP and physical performance in 1491 individuals who attended the second follow-up visit of the Wakayama Spine Study. The sagittal vertical axis at C7 (C7 SVA) was measured by a spine surgeon. The occurrence of LBP within one month, pain intensity, Oswestry Disability Index (ODI), and physical performance (grip strength, 6-m walking time, chair stand test, one-leg standing test) were also evaluated. LBP in the previous month was determined using ODI, and indicators of physical performance were measured. The mean C7 SVA was 11.0 ± 42.7 mm and was significantly greater in older participants (p < 0.001). LBP was more prevalent in participants with a greater C7 SVA (< 40 mm, 35.7%; 40–95 mm, 47.3%; ≥ 95 mm, 59.4%; p < 0.001) and those with a higher ODI score (10.0%, 17.5%, and 29.4%, respectively; p < 0.001). Physical performance significantly decreased in participants with a greater C7 SVA (p < 0.001). Multiple linear regression analysis revealed that LBP and physical performance were significantly associated with C7 SVA (p < 0.001). Thus, sagittal spinal malalignment may lead to LBP and decreased physical performance.

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