Cervical Spine Alignment in the Sagittal Axis: A Review of the Best Validated Measures in Clinical Practice

Martini, Michael L; Neifert, Sean N; Chapman, Emily; Mroz, Thomas E.; Rasouli, Jonathan

doi:10.1177/2192568220972076

Cited by 48 publications

(33 citation statements)

References 29 publications

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“…Sagittal radiograph ( Figure 1A ) demonstrated a reversed cervical lordosis. Global cervical lordosis, 16 defined as Cobb’s angle between C2 and C7 inferior endplate, was –22°. Several of the vertebrae were wedge-shaped, allowing for slippage (pseudosubluxation or physiological anterolisthesis) 17 of the C2 on C3 and C3 on C4, which could be seen as normal variants in children.…”

Section: Case Reportmentioning

confidence: 99%

Cervicogenic Dizziness in an 11-Year-Old Girl: A Case Report

Chu

Wong

2021

AHMT

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Cervicogenic dizziness (CGD) is a syndrome of neck pain accompanied by a false sensation of unsteadiness and dizziness due to neck pathology. An 11-year-old girl presented with neck pain and dizziness for four months. According to the patient’s statement, her complaints were likely related to the prolonged smartphone use for texting. Sagittal radiograph showed cervical kyphosis, anterior wedging of several vertebrae, and mild anterolisthesis of C2 on C3 and C3 on C4. These findings might be present in as physiological variants in children. However, continuous static stress in the minor variants could aggravate biomechanical problems, such as cervicogenic dizziness. After ruling out other neurological or vestibular problems, a multicomponent approach consisted of thermal ultrasound therapy, cervical manipulation, and intermittent motorized cervicothoracic traction to release cervical complaints. Three months later, the patient reported a resolution of neck pain and dizziness. At 12-month follow-up, all radiographic metrics showed improvement, including restoration of cervical alignment and lordotic curvature. The immature growing cervical spine has unique anatomic, physiologic and biomechanical features. A static neck flexion can lead to typical injury patterns seen in this age group. This article aims to raise awareness of the potential harms of excessive smartphone use by children.

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Section: Case Reportmentioning

confidence: 99%

Cervicogenic Dizziness in an 11-Year-Old Girl: A Case Report

Chu

Wong

2021

AHMT

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“…Some studies indicate the C2 angle correlates to TS-CL and can be used as a single, simplified measure of cervical alignment. 9 In comparison with the patient in E, the patient in D has a markedly elevated C2 angle indicating a higher TS-CL value and, thus, higher sagittal malalignment. Adapted from open-source material from Martini, et al 9 Adaptations are themselves works protected by copyright.…”

Section: Computed Tomography (Ct)mentioning

confidence: 86%

New Imaging Modalities for Degenerative Cervical Myelopathy

Rajan

Pelle

Savage

2022

Clinical Spine Surgery: A Spine Publication

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Introduction: Degenerative cervical myelopathy (DCM) is defined as dysfunction of the spinal cord as a result of compression from degenerative changes to surrounding joints, intervertebral disks, or ligaments. Symptoms can include upper extremity numbness and diminished dexterity, difficulty with fine manipulation of objects, gait imbalance, and incoordination, and compromised bowel and bladder function. Accurate diagnosis and evaluation of the degree of impairment due to degenerative cervical myelopathy remain a challenging clinical endeavor requiring a thorough and accurate history, physical examination, and assessment of imaging findings. Methods: A narrative review is presented summarizing the current landscape of imaging modalities utilized in DCM diagnostics and the future direction of research for spinal cord imaging. Results and Discussion: Current imaging modalities, particularly magnetic resonance imaging and, to a lesser extent, radiographs/CT, offer important information to aid in decision making but are not ideal as stand-alone tools. Newer imaging modalities currently being studied in the literature include diffusion tensor imaging, MR spectroscopy, functional magnetic resonance imaging, perfusion imaging, and positron emission tomography. These newer imaging modalities attempt to more accurately evaluate the physical structure, intrinsic connectivity, biochemical and metabolic function, and perfusion of the spinal cord in DCM. Although there are still substantial limitations to implementation, future clinical practice will likely be revolutionized by these new imaging modalities to diagnose, localize, surgically plan and manage, and follow patients with DCM.

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“…Many of these parameters including the T1 slope has been studied in recent years and our understanding of these parameters and how they relate to global spinal parameters continue to evolve. 38 For instance, the T1 slope is a measure that is increasingly being studied as a surrogate for the amount of cervical lordosis required. It is defined as the angle between a line drawn across the upper endplate of the T1 vertebra and the horizontal axis.…”

Section: A C C E P T E D a R T I C L Ementioning

confidence: 99%

Association of Spinal Alignment Correction With Patient-Reported Outcomes in Adult Cervical Deformity: Review of the Literature

et al. 2021

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Adult cervical deformity (ACD) is a debilitating spinal condition that causes significant pain, neurologic dysfunction, and functional impairment. Surgery is often performed to correct cervical alignment, but the optimal amount of correction required to improve patient-reported outcomes (PROs) are not yet welldefined.Method: A review of the literature was performed and Fisher's z-transformation (Zr) was used to pool the correlation coefficients between alignment parameters and PROs. The strength of correlation was defined according to the following: poor (0 < r ≤ 0.3), fair (0.3 < r ≤ 0.5), moderate (0.5 < r ≤ 0.8), and strong (0.8 < r ≤ 1).Results: Increased C2-C7 SVA was fairly associated with increased Neck Disability Index (NDI) (pooled Zr = 0.31; 95% CI, -0.03, 0.58). Changes in TS-CL poorly correlated with NDI (pooled Zr = -0.04; 95% CI, -0.23-0.30). Increased C7-S1 was poorly associated with worse EQ-5D (pooled Zr = -0.22; 95% CI, -0.36, -0.06). Correction of horizontal gaze (CBVA) did not correlate with legacy metrics. mJOA correlated with C2-slope, C7-S1, and C2-S1. Conclusion:Spinal alignment parameters variably correlated with improved HRQoL and myelopathy after corrective surgery for ACD. Further studies evaluating legacy PROs, PROMIS, and ACD specific instruments are needed for further validation.

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Cervical Spine Alignment in the Sagittal Axis: A Review of the Best Validated Measures in Clinical Practice

Cited by 48 publications

References 29 publications

Cervicogenic Dizziness in an 11-Year-Old Girl: A Case Report

Cervicogenic Dizziness in an 11-Year-Old Girl: A Case Report

New Imaging Modalities for Degenerative Cervical Myelopathy

Association of Spinal Alignment Correction With Patient-Reported Outcomes in Adult Cervical Deformity: Review of the Literature

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