Relation between alignments of upper and subaxial cervical spine: a radiological study

Guo, Qunfeng; Ni, Bin; Yang, Jian; Li, Kai; Sun, Zhichao; Zhou, Fang; Zhang, Jianxin

doi:10.1007/s00402-011-1265-x

Cited by 64 publications

(53 citation statements)

References 12 publications

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“…The Guo et al study also revealed slight differences with regard to sex and age in the occipitocervical alignment of healthy volunteers. 4 In our sample, age correlated only with C-7 SVA and C-7 slope, and differences between sexes were observed for C2-7 Cobb angle and C-7 slope only. However, the limited sample sized did not allow for further comparisons among age groups.…”

Section: Normal Values Sex and Age Differencescontrasting

confidence: 56%

“…Previously, this effect was demonstrated for healthy persons only. 4 The negative correlation between the occipitocervical and subaxial spine could also be observed between C1-2 and C2-7, but the correlation coefficient was slightly smaller than that of the interdependence of Oc-C2 and C2-7. Guo et al 4 performed both measurements in asymptomatic healthy volunteers and found that C1-2 alignment correlated better with that of C2-7 than that of Oc-C2, but the differences they observed were small.…”

Section: Cervical Interdependencesmentioning

confidence: 87%

“…Guo et al 4 reported mean values for Oc-C2 and C2-7 Cobb angle as -14.9° and -22.5° for male patients and -16.3° and -12.7° for female patients, respectively. In our sample of patients, Oc-C2 and C2-7 Cobb were slightly higher.…”

Section: Normal Values Sex and Age Differencesmentioning

confidence: 99%

“…Compensatory cervical mechanisms might change with age, and differences have already been observed in previous studies of healthy volunteers. 4 Larger studies are needed to further explore this issue.…”

Section: Normal Values Sex and Age Differencesmentioning

confidence: 99%

“…4,20 Although the number of reports emphasizing the value of lordosis correction is increasing and the existence of compensatory mechanisms between the upper and lower cervical spine have been established, the target magnitude of lordosis restoration in individual patients remains unknown. For accurate surgical planning that specifically addresses lordosis correction, further knowledge of cervical sagittal alignment is paramount.…”

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confidence: 99%

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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

Núñez-Pereira

Hitzl

Bullmann

et al. 2015

SPI

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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.

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Section: Normal Values Sex and Age Differencescontrasting

confidence: 56%

Section: Cervical Interdependencesmentioning

confidence: 87%

Section: Normal Values Sex and Age Differencesmentioning

confidence: 99%

Section: Normal Values Sex and Age Differencesmentioning

confidence: 99%

mentioning

confidence: 99%

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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

Núñez-Pereira

Hitzl

Bullmann

et al. 2015

SPI

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Sagittal wedging of intervertebral discs and vertebral bodies in the cervical spine and their associations with age, sex and cervical lordosis: A large‐scale morphological study

et al. 2021

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Many recent studies have focused on the functional and clinical importance of cervical lordosis. However, there is little accurate knowledge of the anatomical parameters that constitute cervical lordosis (i.e., the sagittal wedging angles of intervertebral discs and vertebral bodies) and their associations with age and sex. Standing lateral cervical radiographs of 1020 subjects (424 males, 596 females) with a mean age of 36.6 ± 17.0 years (range 7–95 years) were evaluated retrospectively. Cervical lordosis, the sum of intervertebral disc wedging angles from C2/C3 to C6/C7 and the sum of vertebral body wedging angles from C3 to C7 were measured. The sum of intervertebral disc wedging and the sum of vertebral body wedging were 20.6° ± 14.7° and −12.8° ± 10.3°, respectively. The sum of intervertebral disc wedging increased significantly with age and was significantly greater in males than females, whereas there was no sex‐related difference in the sum of vertebral body wedging. The sum of intervertebral disc wedging was negatively correlated with sum of vertebral body wedging. Wedging of discs contributed to C2–C7 cervical lordosis more significantly than wedging of vertebral bodies. There were moderate positive correlations between cervical lordosis and intervertebral disc wedging angles at C3/C4, C4/C5 and C5/C6; weak correlations were observed at C2/C3 and C6/C7. This study constitutes the largest currently available analysis comprehensively documenting the anatomical characteristics of sagittal wedging of intervertebral discs and vertebral bodies in the cervical spine. The findings could improve understanding of the internal architecture of cervical lordosis among clinicians.

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Surgical overreduction and hyperlordotic fusion of C1–C2 joint are associated with cervical sagittal malalignment

Huang

Qian

Qiu

et al. 2017

Arch Orthop Trauma Surg

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Relation between alignments of upper and subaxial cervical spine: a radiological study

Cited by 64 publications

References 12 publications

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

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

Sagittal wedging of intervertebral discs and vertebral bodies in the cervical spine and their associations with age, sex and cervical lordosis: A large‐scale morphological study

Surgical overreduction and hyperlordotic fusion of C1–C2 joint are associated with cervical sagittal malalignment

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