Is It Possible to Evaluate the Parameters of Cervical Sagittal Alignment on Cervical Computed Tomographic Scans?

Jun, Hyo Sub; Chang, In Bok; Song, J. J.; Kim, So Yeon; Park, Moon Soo; Kim, Seok Woo; Oh, Jae Keun

doi:10.1097/brs.0000000000000281

Cited by 65 publications

(55 citation statements)

References 20 publications

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“…TIA was revealed to be comparable on lateral neutral radiographs with CT scans, whereas T1 slope and cervical lordosis were impaired by supine position [12]. TIA measured on CT scans in supine position is reported to correlate with T1 slope, NT and, with cervical lordosis [12,13]. Further clinical studies on implications of thoracic inlet parameters are needed.…”

Section: Discussionmentioning

confidence: 90%

“…While, according to Jun et al, TIA correlates with T1 slope and with NT, but not with the C2-C7 lordosis measured on radiographs [12]. TIA was revealed to be comparable on lateral neutral radiographs with CT scans, whereas T1 slope and cervical lordosis were impaired by supine position [12]. TIA measured on CT scans in supine position is reported to correlate with T1 slope, NT and, with cervical lordosis [12,13].…”

Section: Discussionmentioning

confidence: 92%

“…We believe that TIA can be useful in clinical practice, especially, since a significant correlation between TIA, T1 slope and NT was described [4,5,12]. However, correlation between TIA and cervical lordosis is not clear.…”

Section: Discussionmentioning

confidence: 92%

“…Lee et al reported significant correlation between TIA and C2-C7 cervical lordosis [4,5]. While, according to Jun et al, TIA correlates with T1 slope and with NT, but not with the C2-C7 lordosis measured on radiographs [12]. TIA was revealed to be comparable on lateral neutral radiographs with CT scans, whereas T1 slope and cervical lordosis were impaired by supine position [12].…”

Section: Discussionmentioning

confidence: 94%

“…In this study, we have focused strictly on the thoracic inlet parameters. Significance of T1 vertebra as a basis of the cervical spine, represented by T1 slope was postulated [3,12]. Knott et al described relevance of the T1 slope as the best correlating parameter with SVA, measured from the tip of the C2 dens, and suggested that based on this parameter, an overall sagittal balance can be established [3].…”

Section: Discussionmentioning

confidence: 99%

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Influence of cervical spine position on the radiographic parameters of the thoracic inlet alignment

et al. 2015

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

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Influence of cervical spine position on the radiographic parameters of the thoracic inlet alignment

et al. 2015

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Capturing the cervical spine shape: Angular measurements versus geometric morphometric methods

Kedar,

Ezra,

Pelleg‐Kallevag

et al. 2024

Clinical Anatomy

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The cervical spine manifests a wide shape variation. However, the traditional methods to evaluate the cervical spine curve were never tested against its actual shape. The study's main aim was to determine whether the shape classification of the cervical spine, based on traditional angular measurements, coincides with each other and with the shape captured by the 2D landmark‐based geometric morphometric method. The study's second aim was to reveal the associations between the cervical spine shape and the demographic parameters, the head's position, and the spine's sagittal balance. CT scans of the cervical spine of 163 individuals were evaluated to achieve these goals. The shape was assessed by measuring the C2–C7 Cobb angle (CA), the C2–C7 posterior tangent angle (PTA), the curvedness of the arch, and by a 2D landmark‐based geometric morphometric method. The position of the head and the sagittal balance of the spine were evaluated by measuring the foramen magnum‐C2 Cobb angle (FMCA) and the T1 slope angle (T1SA), respectively. Based on the size of the angle measured, each individual was classified into one of the three cervical ‘shape groups’ (lordotic, straight, and kyphotic). We found that cervical lordosis was the dominant shape regardless of the measuring methods utilized (46.6%–54.6%), followed by straight neck (28.2%–30.1%), and kyphosis (15.3%–25.2%); however, about a third of the 163 individuals were classified into a different shape group using the CA and PTA methods. The cervical spine angle was sex‐independent and age‐dependent. The T1SA was significantly correlated with CA and PTA (r = 0.640 and r = 0.585, respectively; p < 0.001). In conclusion, the cervical spine shape evaluation is method‐dependent and varies with age.

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Changes in intervertebral sagittal alignment of the cervical spine from supine to upright

Oyekan

LeVasseur

Shaw

et al. 2022

Journal Orthopaedic Research

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Cervical sagittal alignment is a critical component of successful surgical outcomes. Unrecognized differences in intervertebral alignment between supine and upright positions may affect clinical outcomes; however, these differences have not been quantified. Sixty-four patients scheduled to undergo one or two-level cervical arthrodesis for symptomatic pathology from C4-C5 to C6-C7, and forty-seven controls were recruited. Upright sagittal alignment was obtained through biplane radiographic imaging and measured using a validated process with accuracy better than 1°in rotation. Supine alignment was obtained from computed tomography scans. Coordinate systems used to measure supine and upright alignment were identical. Distances between adjacent bony endplates were measured to calculate disc height in each position. For both patients and controls, the C1-C2, C2-C3, and C3-C4 motion segments were in more lordosis when upright as compared with supine (all p < 0.001). However, the C4-C5, C5-C6, and C6-C7 motion segments were in less lordosis when upright as compared with supine (all p ≤ 0.004). There was an interaction between group and position at the C1-C2 (p = 0.002) and C2-C3 (p = 0.001) motion segments, with the controls demonstrating a greater increase in lordosis at both motion segments when moving from supine to upright. The results indicate that cervical motion segment alignment changes between supine and upright positioning, those changes differ among motion segments, and cervical pathology affects the magnitude of these changes. Clinical Significance:Surgeons should be mindful of the differences in alignment between supine and upright imaging and the implications they may have on clinical outcomes.

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Is It Possible to Evaluate the Parameters of Cervical Sagittal Alignment on Cervical Computed Tomographic Scans?

Abstract: This difference may be due to the differing effect of gravity upon the spine between the upright versus the supine position. Accordingly, TIA and T1 slope may be used as a guide for the assessment of sagittal balance of the cervical spine.

Cited by 65 publications

References 20 publications

Influence of cervical spine position on the radiographic parameters of the thoracic inlet alignment

Influence of cervical spine position on the radiographic parameters of the thoracic inlet alignment

Capturing the cervical spine shape: Angular measurements versus geometric morphometric methods

Changes in intervertebral sagittal alignment of the cervical spine from supine to upright

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