Relationship among Cervical, Thoracic, and Lumbopelvic Sagittal Alignment in Healthy Adults

Endo, Kenji; Suzuki, Hidekazu; Sawaji, Yasunobu; Nishimura, Hirosuke; Yorifuji, Makiko; Murata, Kazuma; Tanaka, Hidetoshi; Shishido, Toetsu; Yamamoto, Kenjiro

doi:10.1177/230949901602400121

Cited by 28 publications

(19 citation statements)

References 22 publications

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“…Some studies have reported a difference between sexes in kyphosis and lordosis angle, showing a higher angle of kyphosis in males and a higher angle of lordosis in females [54,55]. However, others have found differences just in kyphosis [56] or just in lordosis [57]. Only one study researched the effect of the exercise on kyphosis angle differences between sexes, finding the same result in both sexes [36].…”

Section: Discussionmentioning

confidence: 99%

Effects of exercise programs on kyphosis and lordosis angle: A systematic review and meta-analysis

2019

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Many authors are interested in the effects that a specific exercise program could have on sagittal spinal curvatures. The purpose of this study was to determine the effects of different exercise programs on thoracic kyphosis and lumbar lordotic angle. This meta-analysis adhered to the PRISMA guideline and it was registered at PROSPERO. Five electronic databases (Pub Med, Cochrane, WOS, PEDro and EBSCO) were searched up to 31 July 2018. Eligible studies were randomized controlled trials that applied an exercise intervention and measured a kyphosis and/or lordotic angle. Study quality was performance by PEDro score. Risk of bias was assessed using the SIGN 50 checklist for randomized controlled trials. External validity was assessed using the EVAT. Ten randomized controlled trials were included for systematic review and meta-analysis. Meta-analysis with a random effect model was performed to infer the pooled estimated standardized mean difference. All studies were RCTs and they involved a total of 284 cases and 255 controls. Seven studies measured kyphosis angle. A large significant effect of the exercise on kyphosis was identified (SMD = -1.400 (95% CI-2.150 a -0.660), p = 0.000). Four studies assessed lordotic angle and moderate but not significant improvement was shown (SMD = -0.530 (95% CI-1.760 a -0.700), p = 0.401). The results suggest that exercise programs may have a positive effect on thoracic kyphosis angle, but no clear effect on lordotic angle. This systematic review suggests that strengthening rather than stretching could be more relevant for kyphosis and both qualities are important for lordosis. It is necessary to conduct more randomized controlled trials to assess the effects of strengthening and/or stretching program on kyphosis and lordotic angle and to establish the type of the exercise that is better for maintaining the sagittal disposition within normal ranges.

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Section: Discussionmentioning

confidence: 99%

Effects of exercise programs on kyphosis and lordosis angle: A systematic review and meta-analysis

2019

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“…Such changes with age may put pressure on cervical spine to change simultaneously causing changes such as increase in lordosis seen by some authors. Whereas in healthy adults (aged 22–50 years), cervical sagittal alignment is found to be associated with thoracic sagittal alignment but not with lumbopelvic alignment [ 49 ] and cervical lordosis inversely correlates with thoracic kyphosis [ 50 ]; in elderly people, cervical curvature is affected by pelvic sagittal alignment [ 51 ]. Lumbar lordosis decreases, and thoracic kyphosis increases with age which results in a compensatory increase in cervical lordosis [ 10 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

Cervical lordosis in asymptomatic individuals: a meta-analysis

Guo

Diao

et al. 2018

J Orthop Surg Res

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BackgroundCervical lordosis has important clinical and surgical implications. Cervical spine curvature is reported with considerable variability in individual studies. The aim of this study was to examine the existence and extent of cervical lordosis in asymptomatic individuals and to evaluate its relationship with age and gender.MethodsA comprehensive literature search was conducted in several electronic databases. Study selection was based on pre-determined eligibility criteria. Random effects meta-analyses were performed to estimate the proportion of asymptomatic individuals with lordosis and the effect size of cervical lordotic curvature in these individuals which followed metaregression analysis to examine the factors affecting cervical lordosis. Data from 21 studies (15,364 asymptomatic individuals, age 42.30 years [95% confidence interval 36.42, 48.18], 54.2% males) were used in the present study.ResultsIn this population, 63.99% [95% confidence interval 44.94, 83.03] individuals possessed lordotic curvature. Degree of lordotic curvature differed by method of measurement; 12.71° [6.59, 18.84] with Cobb C2–C7 method and 18.55° [14.48, 22.63] with posterior tangent method. Lordotic curvature was not significantly different between symptomatic and asymptomatic individuals but was significantly higher in males in comparison with females. Age was not significantly associated with lordotic cervical curvature.ConclusionMajority of the asymptomatic individuals possesses lordotic cervical curvature which is higher in males than in females but have no relationship with age or symptoms.

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“…It is known that the C2-C7 angle is well correlated with T1S and global thoracic curvature in the up-right neutral position. 3,4 The present study demonstrated that cervical sagittal motion affects the T1S and T5-T8 angle, but the T1-T4 angle, T9-T12 angle, and lumbo-pelvic columns did not change significantly. The reciprocal change of T1-T4 angle was smaller than that of T5-T8 angle upon cervical flexion and extension.…”

Section: Discussionmentioning

confidence: 43%

Effect of cervical flexion and extension on thoracic sagittal alignment

Konishi

Endo

Aihara

et al. 2019

J Orthop Surg (Hong Kong)

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Introduction: The cervical spine has the largest sagittal motion in the whole spine, and cervical alignment affects the thoracic sagittal alignment. However, the effects of cervical flexion and extension on thoracic sagittal alignment have not been investigated in detail. The purpose of this study was to analyze the change of thoracic sagittal alignment following cervical flexion and extension. Subjects and methods: A total of 55 consecutive patients (42 men and 13 women; average age 49.1 years) who presented to our department with spinal degenerative disease between January 2016 and September 2017 were enrolled in our study. Subjects with a history of trauma, infection, tumor, inflammatory disease, ossification, or cervical deformities, and those who had undergone spinal surgery were excluded. The following parameters were analyzed: occipito-axial angle (O–C2), C2 slope (C2S), C2–C7 angle, T1 slope (T1S), thoracic kyphosis, T1–T4 angle, T5–T8 angle, T9–T12 angle, lumbar lordosis, sacral slope, pelvic tilt in cervical flexion, neutral, and extension. Results: Cervical flexion significantly decreased O–C2, C2–C7 angles and T1S, and increased C2S. Cervical extension conversely changed these parameters. At cervical flexion, the correlation of C2–C7 angle with thoracic parameters was maintained, except for the T1–T4 angle. At cervical extension, the correlation was observed with T1S and T1–T4 angle. Conclusion: Cervical flexion affects the T1S and T5–T8 angle, but there is no significant change in T1–T4 and T9 and lower spino-pelvic columns. This study suggests that T2–T4 can be considered as a stable distal end when cervical long fixation for corrective surgery is performed.

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Relationship among Cervical, Thoracic, and Lumbopelvic Sagittal Alignment in Healthy Adults

Cited by 28 publications

References 22 publications

Effects of exercise programs on kyphosis and lordosis angle: A systematic review and meta-analysis

Effects of exercise programs on kyphosis and lordosis angle: A systematic review and meta-analysis

Cervical lordosis in asymptomatic individuals: a meta-analysis

Effect of cervical flexion and extension on thoracic sagittal alignment

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