Analysis of cervical spine alignment in currently asymptomatic individuals: prevalence of kyphotic posture and its relationship with other spinopelvic parameters

Kim, Seok Woo; Kim, Tae‐Hwan; Bok, Do Hee; Jang, Chul-Young; Yang, Myung Ho; Lee, Seon-Jong; Yoo, Je Hyun; Kwak, Yoon Hae; Oh, Jae Keun

doi:10.1016/j.spinee.2017.09.008

Cited by 33 publications

(38 citation statements)

References 11 publications

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“…When the motion segments were divided into the upper cervical spine (C0-C2) and the lower cervical spine (C2-C7), each segment showed a distinctive ROM that served to preserve spinal functioning, especially horizontal gazing of the cervical spine. Also, this study identified that the correlation between the cervical spine and the global spine parameters (i.e., TK, LL, SS, PT, and PI) was not statistically significant, explaining the proper cervical spine alignment or ROM that moves the spine according to its relations with the head as the center is more necessary than focusing on the correlation between the cervical spine and the spinopelvic parameters [9].…”

Section: Discussionmentioning

confidence: 86%

“…The group with kyphotic alignment can be subdivided into reducible kyphosis, in which the kyphotic curvature recovers to lordotic alignment in the lateral radiograph upon extension, and non-reducible kyphosis, in which the kyphotic alignment is sustained upon extension. According to this classification, among the 26.3% of subjects with kyphotic alignment, 15.7% (of the full 958-person cohort) was determined as non-reducible kyphosis [9].…”

Section: Introductionmentioning

confidence: 99%

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Analysis of Cervical Spine Alignment and its Relationship with Other Spinopelvic Parameters after Laminoplasty in Patients with Degenerative Cervical Myelopathy

Kim

Jang

Lee

et al. 2020

JCM

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For patients with kyphosis of the cervical spine, laminoplasty is usually incapable of improving neurological symptoms as it worsens kyphotic alignment. Thus, laminoplasty is not recommended in the presence of kyphotic alignment. Nevertheless, laminoplasty may be selected for myelopathy due to multiple-segment intervertebral disc herniation or ossification of posterior longitudinal ligament despite kyphotic alignment. This study examined whether cervical alignment influences surgical outcomes. Cervical alignment before the surgery was classified into lordosis and non-lordosis, and the non-lordosis group was subclassified into reducible and non-reducible groups to determine the change in cervical alignment before and after the surgery and to analyze its relationship with spinopelvic parameters. The lordosis group showed an increase in upper cervical motion (C0-2 Range of Motion (ROM), C0-2ROM/C0-7ROM) after surgery, while the non-lordosis group exhibited a decrease in C2-7ROM and C0-7ROM. The C0-2ROM was maintained without any reduction in the reducible group, while there was no significant change in cervical alignment and ROM of the non-reducible group. None of these changes showed significant association with the spinopelvic parameters of other sites. However, having a non-reducible type non-lordosis is not a proper indication for laminoplasty, as it does not change the alignment after surgery. Therefore, cervical alignment and reducibility should be identified before surgery.

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Section: Discussionmentioning

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Analysis of Cervical Spine Alignment and its Relationship with Other Spinopelvic Parameters after Laminoplasty in Patients with Degenerative Cervical Myelopathy

Kim

Jang

Lee

et al. 2020

JCM

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“…Lee found no direct correlation between pelvic parameters and thoracic or cervical spine alignment [12]. Kim found no statistically significant correlations were found among cervical kyphosis and the global spine parameters [4]. Miao found that the cervical angles were related to thoracic angles, but not with the lumbar angles.…”

Section: Discussionmentioning

confidence: 94%

“…Lee found a significant sequential relationship between C2-7 angle and T1 slope in asymptomatic volunteers without the history of symptoms related to the whole spine [3]. In Kim's study, nearly onefourth of the asymptomatic participants (26.3%) have kyphotic cervical posture and no statistically significant correlations were found among cervical kyphosis and the global spine parameters (TK, LL, SS, PT, and PI) [4]. One study showed that C2-7 angle was the only predictor of CSVA in patients with cervical spondylotic myelopathy.…”

Section: Introductionmentioning

confidence: 84%

“…Kyphotic alignment of the cervical spine cannot alone define cervical deformity [10,13]. Kim's report showed that nearly onefourth of asymptomatic people have kyphotic cervical posture [4]. Yoshida's study demonstrated that the pathology of the responsible lesion was related to global sagittal balance but not regional cervical alignment, which might be due to compensation against global malalignment during aging [11].…”

Section: Discussionmentioning

confidence: 99%

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

Zhu

Shen

et al. 2020

Preprint

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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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Single‐level cervical disc arthroplasty in the spine with reversible kyphosis: A finite element study

Jiang

Hong

et al. 2022

JOR Spine

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Background: Our previous studies found the single-level cervical disc arthroplasty (CDA) might be a feasible treatment for the patients with reversible kyphosis (RK).Theoretically, the change of cervical alignment from lordosis to RK comes with the biomechanical alteration of prostheses and cervical spine. However, the biomechanical data of CDA in the spine with RK have not been reported. This study aimed at establishing finite element (FE) models to (1) explore the effects of RK on the biomechanics of artificial cervical disc; (2) investigate the biomechanical differences of single-level anterior cervical discectomy and fusion (ACDF) and CDA in the cervical spine with RK. Methods:The FE models of the cervical spine with lordosis and RK were constructed, then three single-level surgical models were developed: (1) RK + ACDF;(2) RK + CDA; (3) lordosis + CDA. A 73.6-N follower load combined with 1 NÁm moment was applied at the C2 vertebra to produce cervical motion.Results: At the surgical level, "lordosis + CDA" had the greatest ROM (except for flexion) while "RK + ACDF" had the minimum ROM. However, at adjacent levels, the ROM of "RK + ACDF" increased by 4.05% to 38.04% in comparison to "RK + CDA.""RK + ACDF" had the greatest prosthesis interface stress, while the maximum prosthesis interface stress of "RK + CDA" was at least 2.15 times higher than "lordosis + CDA." Similarly, "RK + ACDF" had the greatest intradiscal pressure (IDP) at adjacent levels, while the IDP of "RK + CDA" was 1.6 to 6.7 times higher than "lordosis + CDA." At the surgical level, "RK + CDA" had the greatest facet joint stress (except for extension), which was 1.9 to 11.2 times higher than "lordosis + CDA." At the adjacent levels, "RK + CDA" had the greatest facet joint stress (except for extension), followed by "RK + ACDF" and "lordosis + CDA" in descending order.Conclusions: RK significantly changed the biomechanics of CDA, which is demonstrated by the decreased ROM and the significantly increased prosthesis interface stress, IDP, and facet joint stress in the "RK + CDA" model. Compared with ACDF, Xu Hu and Majiao Jiang have contributed equally to this work and share the first authorship.

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Analysis of cervical spine alignment in currently asymptomatic individuals: prevalence of kyphotic posture and its relationship with other spinopelvic parameters

Cited by 33 publications

References 11 publications

Analysis of Cervical Spine Alignment and its Relationship with Other Spinopelvic Parameters after Laminoplasty in Patients with Degenerative Cervical Myelopathy

Analysis of Cervical Spine Alignment and its Relationship with Other Spinopelvic Parameters after Laminoplasty in Patients with Degenerative Cervical Myelopathy

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

Single‐level cervical disc arthroplasty in the spine with reversible kyphosis: A finite element study

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