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

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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Cervical sagittal alignment in patients with dropped head syndrome

Journal of Orthopaedic Surgery ◽

10.1177/2309499021990112 ◽

2021 ◽

Vol 29 (1) ◽

pp. 230949902199011

Author(s):

Weiqing Qian ◽

Kenji Endo ◽

Takato Aihara ◽

Yasunobu Sawaji ◽

Hidekazu Suzuki ◽

...

Keyword(s):

Cervical Spondylosis ◽

Sagittal Alignment ◽

Vertical Axis ◽

Spinal Alignment ◽

Sagittal Vertical Axis ◽

Dropped Head Syndrome ◽

Sagittal Spinal Alignment ◽

Cervical Sagittal Alignment ◽

Lumbar Alignment ◽

The Relationship

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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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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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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Detection of mild cognitive impairment by spinal posture assessment in health exams of the general older population: A Japanese cohort survey randomly sampled from a basic resident registry

10.21203/rs.3.rs-861016/v1 ◽

2021 ◽

Author(s):

Hikaru Nishimura ◽

Shota Ikegami ◽

Masashi Uehara ◽

Jun Takahashi ◽

Ryosuke Tokida ◽

...

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Cognitive Function ◽

Adult Population ◽

Vertical Axis ◽

Community Dwelling ◽

Sagittal Vertical Axis ◽

Spinal Balance ◽

Japanese Cohort ◽

Sagittal Spinal Balance

Abstract The recent increase in the older adult population has led to a higher prevalence of cognitive impairment, which is often overlooked in routine health examinations. Citizens aged 50 to 89 years were targeted for this cohort survey by random sampling from the resident registry of a cooperating town in 2014. A total of 413 participants (203 male and 210 female) were enrolled. We analyzed the distribution of cognitive function test scores as determined by Montreal Cognitive Assessment and Mini-Mental State Examination tests in each age (50’s, 60’s, 70’s and 80’s) and sex group to examine whether mild cognitive impairment (MCI) could be detected by sagittal spinal balance measurement based on a radiological approach. Sagittal spinal balance was quantitatively measured as sagittal vertical axis (SVA). We observed significant associations for higher age and/or SVA anteriorization with lower cognitive function. In men, spinal balance anteriorization was associated with MCI independently of age, with combinations of age and SVA also making valid MCI determinations; male cases of SVA ≥ 100 mm at any age, SVA ≥ 90 mm at ≥ 70 years, and SVA ≥ 70 mm at ≥ 80 years were all more likely to have MCI than cases below those values. For women, MCI was more likely in cases of SVA ≥ 70 mm, regardless of age. Thus, spinal balance anteriorization can be regarded as an easily visible indicator of latent MCI in community-dwelling older people.

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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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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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Analysis of the Effect of Backpack Design with Reduced Load Moment Arm on Spinal Alignment

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16224351 ◽

2019 ◽

Vol 16 (22) ◽

pp. 4351

Author(s):

Kyung-hun Kim ◽

Jihyeon Ann ◽

Sang-hun Jang

Keyword(s):

Lumbar Lordosis ◽

Pelvic Incidence ◽

Vertical Axis ◽

Center Of Gravity ◽

The Body ◽

Moment Arm ◽

Spinal Alignment ◽

Sagittal Vertical Axis ◽

Sagittal Spinal Alignment ◽

Significant Difference

In this study, we designed a backpack that can reduce the moment arm of backpack load by placing the center of gravity of the backpack close to the axis of the spine. In order to investigate the effect of sagittal spinal alignment compared with the general backpack, we conducted the study using radiological images. The participants in this study were 18 adults (8 males and 10 females). The subjects participated in the experiment without carrying the backpack, wearing the normal backpack, and wearing a backpack designed to reduce the load moment arm by placing the center of gravity close to the body. Spinal alignment parameters were measured and analyzed using 3D radiography measurement software based on radiographic images taken under three conditions. The overall angle of lumbar lordosis, upper arc, lower arc, difference between pelvic incidence and lumbar lordosis, lower cervical lordosis, and sagittal vertical axis were measured. In the case of wearing the backpack rather than without the backpack, there was a significant difference in the overall angle of lumbar lordosis, lower arc, lower cervical spine angle, difference between pelvic incidence and lumbar lordosis, and sagittal vertical axis. In the case of wearing the backpack with reduced moment arm, the overall angle and lower arc of lumbar lordosis were significantly increased compared to those with the normal backpack. The difference between pelvic incidence and lumbar lordosis was significantly decreased. The results showed that a normal backpack caused imbalance of sagittal spinal alignment, and the backpack reducing the load moment arm by placing the backpack’s center of gravity close to the vertebral joint played a positive role in reducing the change of lumbar alignment compared with the normal backpack.

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Relationship of Sagittal Spinal Alignment With Low Back Pain And Physical Performance In A Population-Based Japanese Cohort: The Wakayama Spine Study

10.21203/rs.3.rs-576310/v1 ◽

2021 ◽

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 ◽

Sagittal Malalignment

Abstract Studies have suggested a relationship between sagittal malalignment of the spine and low back pain (LBP). The Wakayama Spine Study investigated the relationship between spinal alignment, LBP, and physical performance in 1491 individuals who attended a second follow-up visit as part of the ROAD Study and for whom standing lateral spinal radiographs were available. The sagittal vertical axis at C7 (C7 SVA) was measured by a spinal surgeon. LBP in the previous month was determined by the Oswestry Disability Index (ODI), and indicators of physical performance were measured. The mean C7 SVA was 11.0 ± 42.7 mm and significantly greater in older subjects (p<0.001). Based on their C7 SVA, the subjects were divided into small (<40 mm), intermediate (40≤SVA<95 mm), and large (≥95 mm) groups. LBP was more prevalent in subjects with a larger C7 SVA (small, 35.7%; intermediate, 47.3%; large, 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 was significantly decreased in subjects with a larger 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 malalignment of the spine may lead to LBP and decreased physical performance.

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Sagittal spinal alignment deviation in the general elderly population: a Japanese cohort survey randomly sampled from a basic resident registry

The Spine Journal ◽

10.1016/j.spinee.2018.06.346 ◽

2019 ◽

Vol 19 (2) ◽

pp. 349-356 ◽

Cited By ~ 13

Author(s):

Masashi Uehara ◽

Jun Takahashi ◽

Shota Ikegami ◽

Ryosuke Tokida ◽

Hikaru Nishimura ◽

...

Keyword(s):

Elderly Population ◽

Spinal Alignment ◽

Japanese Cohort ◽

Sagittal Spinal Alignment ◽

Alignment Deviation ◽

General Elderly Population

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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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