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 Correlation between cervical spine sagittal alignment and clinical outcome after cervical laminoplasty for ossification of the posterior longitudinal ligament

2016 ◽  
Vol 24 (1) ◽  
pp. 100-107 ◽  
Author(s):  
Chang Kyu Lee ◽  
Dong Ah Shin ◽  
Seong Yi ◽  
Keung Nyun Kim ◽  
Hyun Chul Shin ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Cobb Angle ◽  
Clinical Outcomes ◽  
Sagittal Alignment ◽  
Short Form ◽  
Japanese Orthopaedic Association ◽  
Posterior Longitudinal Ligament ◽  
Cervical Laminoplasty ◽  
Sf 36 ◽  
Cervical Sagittal Alignment

OBJECT The goal of this study was to determine the relationship between cervical spine sagittal alignment and clinical outcomes after cervical laminoplasty in patients with ossification of the posterior longitudinal ligament (OPLL). METHODS Fifty consecutive patients who underwent a cervical laminoplasty for OPLL between January 2012 and January 2013 and who were followed up for at least 1 year were analyzed in this study. Standing plain radiographs of the cervical spine, CT (midsagittal view), and MRI (T2-weighted sagittal view) were obtained (anteroposterior, lateral, flexion, and extension) pre- and postoperatively. Cervical spine alignment was assessed with the following 3 parameters: the C2–7 Cobb angle, C2–7 sagittal vertical axis (SVA), and T-1 slope minus C2–7 Cobb angle. The change in cervical sagittal alignment was defined as the difference between the post- and preoperative C2–7 Cobb angles, C2–7 SVAs, and T-1 slope minus C2–7 Cobb angles. Outcome assessments (visual analog scale [VAS], Oswestry Neck Disability Index [NDI], 36-Item Short-Form Health Survey [SF-36], and Japanese Orthopaedic Association [JOA] scores) were obtained in all patients pre- and postoperatively. RESULTS The average patient age was 56.3 years (range 38–72 years). There were 34 male patients and 16 female patients. Cervical laminoplasty for OPLL helped alleviate radiculomyelopathy. Compared with the preoperative scores, improvement was seen in postoperative VAS and JOA scores. After laminoplasty, 35 patients had kyphotic changes, and 15 had lordotic changes. However, cervical sagittal alignment after laminoplasty was not significantly associated with clinical outcomes in terms of postoperative improvement of the JOA score (C2–7 Cobb angle: p = 0.633; C2–7 SVA: p = 0.817; T-1 slope minus C2–7 lordosis: p = 0.554), the SF-36 score (C2–7 Cobb angle: p = 0.554; C2–7 SVA: p = 0.793; T-1 slope minus C2–7 lordosis: p = 0.829), the VAS neck score (C2–7 Cobb angle: p = 0.263; C2–7 SVA: p = 0.716; T-1 slope minus C2–7 lordosis: p = 0.497), or the NDI score (C2–7 Cobb angle: p = 0.568; C2–7 SVA: p = 0.279; T-1 slope minus C2–7 lordosis: p = 0.966). Similarly, the change in cervical sagittal alignment was not related to the JOA (p = 0.604), SF-36 (p = 0.308), VAS neck (p = 0.832), or NDI (p = 0.608) scores. CONCLUSIONS Cervical laminoplasty for OPLL improved radiculomyelopathy. Cervical laminoplasty increased the probability of cervical kyphotic alignment. However, cervical sagittal alignment and clinical outcomes were not clearly related.

scholarly journals The association of cervical sagittal alignment with adjacent segment degeneration

2019 ◽  
Vol 29 (11) ◽  
pp. 2655-2664 ◽  
Author(s):  
Xiaoyu Yang ◽  
Ronald H. M. A. Bartels ◽  
Roland Donk ◽  
Mark P. Arts ◽  
Caroline M. W. Goedmakers ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Sagittal Alignment ◽  
Neck Disability Index ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Trial Register ◽  
Sf 36 ◽  
Cervical Sagittal Alignment ◽  
Intervertebral Cage

Abstract Purpose Cervical spine surgery may affect sagittal alignment parameters and induce accelerated degeneration of the cervical spine. Cervical sagittal alignment parameters of surgical patients will be correlated with radiological adjacent segment degeneration (ASD) and with clinical outcome parameters. Methods Patients were analysed from two randomized, double-blinded trials comparing anterior cervical discectomy with arthroplasty (ACDA), with intervertebral cage (ACDF) and without intervertebral cage (ACD). C2–C7 lordosis, T1 slope, C2–C7 sagittal vertical axis (SVA) and the occipito-cervical angle (OCI) were determined as cervical sagittal alignment parameters. Radiological ASD was scored by the combination of decrease in disc height and anterior osteophyte formation. Neck disability index (NDI), SF-36 PCS and MCS were evaluated as clinical outcomes. Results The cervical sagittal alignment parameters were comparable between the three treatment groups, both at baseline and at 2-year follow-up. Irrespective of surgical method, C2–C7 lordosis was found to increase from 11° to 13°, but the other parameters remained stable during follow-up. Only the OCI was demonstrated to be associated with the presence and positive progression of radiological ASD, both at baseline and at 2-year follow-up. NDI, SF-36 PCS and MCS were demonstrated not to be correlated with cervical sagittal alignment. Likewise, a correlation with the value or change of the OCI was absent. Conclusion OCI, an important factor to maintain horizontal gaze, was demonstrated to be associated with radiological ASD, suggesting that the occipito-cervical angle influences accelerated cervical degeneration. Since OCI did not change after surgery, degeneration of the cervical spine may be predicted by the value of OCI. NECK trial Dutch Trial Register Number NTR1289. PROCON trial Trial Register Number ISRCTN41681847. Graphic abstract These slides can be retrieved under Electronic Supplementary Material.

scholarly journals Analysis of the relationship between Modic change and spinopelvic alignment parameters in degenerative scoliosis patients

2020 ◽  
Author(s):  
Haosheng Wang ◽  
Hao Hu ◽  
Xueliang Cheng ◽  
Yang Qu
Keyword(s):  
Sagittal Alignment ◽  
Sacral Slope ◽  
Degenerative Scoliosis ◽  
Sagittal Vertical Axis ◽  
Radiographic Findings ◽  
Healthy Group ◽  
Coronal Balance ◽  
Spinopelvic Alignment ◽  
Sagittal Parameters ◽  
Age And Sex

Abstract Background: Sagittal alignment and coronal balance have been considered to be important in treating patients with degenerative scoliosis (DS). Previous studies have reported that Modic changes (MCs), disc degeneration (DD),and facet tropism(FT) have been considered as major factors forspinopelvic alignment parameters inpatients with DS. However, no previous study has investigated relationship between them.Methods: Our retrospective study recruited 38 DS patients and41 healthy age and sex matched individuals.The DS patientswere divided into DS group andhealthy age and sex matched individuals were divided into healthy group.Full‑length frontal and lateral views of the entire spine was measured to evaluate sagittal alignment and coronal balance. Endplate-disc-facetjoints degeneration of patients with DS were quantified using the Modic classifications, DD, and FT.The spinopelvic alignment parameters were measured, including pelvic incidence,sacral slope,lumbar lordosis, thoracic kyphosis, C7-sagittal vertical axis, L3 tilt, coronal balance distance, coronal cobb angel, thoracolumbar junctional angle, T1 pelvic angle.Results:Based on radiographic findings, the incidence of MCs at different lumbar level was higher percentage of participants showed MCsand FT in the DS group (DS group: 52.63%, healthy group: 11.24%). The coronal and sagittal parameters were significantly different between DS group and healthy group (p<0.05), except for SS (>0.05).Besides, there was significant correlation between the coronal and sagittal parameters.Conclusions: Coronal deformity has little effect on sagittal parameter sexcept for SVA, TK, and LLI. Besides, differentcoronal deformity types show weak difference on sagittal plan. The prevalence of MC in DLS group is higher than healthy group, which result in poorer clinical outcomes.

scholarly journals The Effect of Early Mobilisation on the Sagittal Alignment and Clinical Outcome Following Conservative Treatment of the AO A3 and A4 Thoracolumbar Spine Fracture in Comparison to A1 Fractures. A Retrospective Study

2021 ◽  
Author(s):  
Mahmoud Elshamly ◽  
Stefan Toegel ◽  
Josef G Grohs
Keyword(s):  
Conservative Treatment ◽  
Clinical Outcome ◽  
Thoracolumbar Spine ◽  
Vertical Axis ◽  
Sacral Slope ◽  
Compensatory Mechanisms ◽  
Sagittal Vertical Axis ◽  
Sagittal Malalignment ◽  
Neurologically Intact

Abstract BackgroundThe aim of the study was to correlate the clinical and radiological outcomes following the conservative treatment of neurologically intact patients with AO A4, A3, and A1 thoracolumbar (TL) fractures.MethodsRetrospective study included 3 cohorts of conservatively treated patients with AO A4, A3, and A1 TL fracture without the use of bracing or casting. At the final follow up segmental kyphotic angle (SKA), regional lordotic angle (RLA), lordosis gap (LG), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), sagittal vertical axis (SVA), lumbar lordosis (LL), thoracic kyphosis (TK), and femoral obliquity angle (FOA), and the Oswestry disability index (ODI) were assessed. Data were analyzed using descriptive statistics, non-parametric inferential statistics, and Spearman correlation analyses.ResultsAge was significantly higher in A4 group than in A1 group (p=0.04). The median 1ry SKA of the A3 group (15 ± 3) was significantly higher than in A1 group (7 ± 7, p=0.04). The median of total ODI in the A4 group (42 ± 53) and A3 group (31.3 ± 27) was clinically higher than in A1 group (11.1 ± 25), however, this difference was not statistically significant. Age as well as SVA correlated significantly with PT, FOA, SKA at the follow up, and the total ODI.ConclusionAge of the patient is a significant confounder that has an important impact on the type of fracture, sagittal malalignment, its compensatory mechanisms, and the resulting clinical outcome following conservative treatment of AO A4 and A3 TL fracture.

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)

Radiographic analysis of the correlation between ossification of the nuchal ligament and sagittal alignment and segmental stability of the cervical spine in patients with cervical spondylotic myelopathy

2018 ◽  
Vol 60 (2) ◽  
pp. 196-203 ◽  
Author(s):  
Jinwei Ying ◽  
Honglin Teng ◽  
Yunfan Qian ◽  
Yingying Hu ◽  
Tianyong Wen ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Cervical Spondylotic Myelopathy ◽  
Sagittal Alignment ◽  
Angular Displacement ◽  
Radiographic Finding ◽  
Control Group ◽  
Chronic Injury ◽  
Sagittal Vertical Axis ◽  
Cervical Sagittal Alignment ◽  
Nuchal Ligament

Background Ossification of the nuchal ligament (ONL) caused by chronic injury to the nuchal ligament (NL) is very common in instability-related cervical disorders. Purpose To determine possible correlations between ONL, sagittal alignment, and segmental stability of the cervical spine. Material and Methods Seventy-three patients with cervical spondylotic myelopathy (CSM) and ONL (ONL group) and 118 patients with CSM only (control group) were recruited. Radiographic data included the characteristics of ONL, sagittal alignment and segmental stability, and ossification of the posterior longitudinal ligament (OPLL). We performed comparisons in terms of radiographic parameters between the ONL and control groups. The correlations between ONL size, cervical sagittal alignment, and segmental stability were analyzed. Multivariate logistic regression was used to identify the independent risk factors of the development of ONL. Results C2–C7 sagittal vertical axis (SVA), T1 slope (T1S), T1S minus cervical lordosis (T1S-CL) on the lateral plain, angular displacement (AD), and horizontal displacement (HD) on the dynamic radiograph increased significantly in the ONL group compared with the control group. The size of ONL significantly correlated with C2–C7 SVA, T1S, AD, and HD. The incidence of ONL was higher in patients with OPLL and segmental instability. Cervical instability, sagittal malalignment, and OPLL were independent predictors of the development of ONL through multivariate analysis. Conclusion Patients with ONL are more likely to have abnormal sagittal alignment and instability of the cervical spine. Thus, increased awareness and appreciation of this often-overlooked radiographic finding is warranted during diagnosis and treatment of instability-related cervical pathologies and injuries.

scholarly journals The Influence of Natural Head Position on the Cervical Sagittal Alignment

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.

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 Cervical spine alignment, sagittal deformity, and clinical implications

2013 ◽  
Vol 19 (2) ◽  
pp. 141-159 ◽  
Author(s):  
Justin K. Scheer ◽  
Jessica A. Tang ◽  
Justin S. Smith ◽  
Frank L. Acosta ◽  
Themistocles S. Protopsaltis ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Cervical Myelopathy ◽  
Sagittal Alignment ◽  
Deformity Correction ◽  
Adjacent Segment ◽  
Sagittal Vertical Axis ◽  
Cervical Alignment ◽  
Cervical Deformity ◽  
Cervical Sagittal Alignment ◽  
Global Sagittal Alignment

This paper is a narrative review of normal cervical alignment, methods for quantifying alignment, and how alignment is associated with cervical deformity, myelopathy, and adjacent-segment disease (ASD), with discussions of health-related quality of life (HRQOL). Popular methods currently used to quantify cervical alignment are discussed including cervical lordosis, sagittal vertical axis, and horizontal gaze with the chin-brow to vertical angle. Cervical deformity is examined in detail as deformities localized to the cervical spine affect, and are affected by, other parameters of the spine in preserving global sagittal alignment. An evolving trend is defining cervical sagittal alignment. Evidence from a few recent studies suggests correlations between radiographic parameters in the cervical spine and HRQOL. Analysis of the cervical regional alignment with respect to overall spinal pelvic alignment is critical. The article details mechanisms by which cervical kyphotic deformity potentially leads to ASD and discusses previous studies that suggest how postoperative sagittal malalignment may promote ASD. Further clinical studies are needed to explore the relationship of cervical malalignment and the development of ASD. Sagittal alignment of the cervical spine may play a substantial role in the development of cervical myelopathy as cervical deformity can lead to spinal cord compression and cord tension. Surgical correction of cervical myelopathy should always take into consideration cervical sagittal alignment, as decompression alone may not decrease cord tension induced by kyphosis. Awareness of the development of postlaminectomy kyphosis is critical as it relates to cervical myelopathy. The future direction of cervical deformity correction should include a comprehensive approach in assessing global cervicalpelvic relationships. Just as understanding pelvic incidence as it relates to lumbar lordosis was crucial in building our knowledge of thoracolumbar deformities, T-1 incidence and cervical sagittal balance can further our understanding of cervical deformities. Other important parameters that account for the cervical-pelvic relationship are surveyed in detail, and it is recognized that all such parameters need to be validated in studies that correlate HRQOL outcomes following cervical deformity correction.

Sign in / Sign up

Export Citation Format

Share Document