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