Relationship between cervical sagittal alignment and health-related quality of life in adolescent idiopathic scoliosis

Youn, Myung Soo; Shin, Jong Ki; Goh, Tae Sik; Kang, Seok; Jeon, Woong Ki; Lee, Jung Sub

doi:10.1007/s00586-016-4488-2

Cited by 58 publications

(39 citation statements)

References 26 publications

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“…It has also been suggested that T-1 slope and C2-7 SVA are related to health-related quality of life in patients with AIS. 23 However, we found no difference in C2-7 SVA according to preoperative CSA. Reportedly, C2-7 lordosis is related to the global thoracic sagittal alignment in Lenke type 5C curves.…”

Section: Discussioncontrasting

confidence: 61%

Cervical sagittal alignment in patients with adolescent idiopathic scoliosis: is it corrected by surgery?

Cho¹,

Hwang²,

Choi³

et al. 2018

Journal of Neurosurgery: Pediatrics

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OBJECTIVECervical sagittal alignment (CSA) is related to function and quality of life, but it has not been frequently studied in patients with adolescent idiopathic scoliosis. This study aimed to reveal the change in CSA following corrective surgery, compare the cervical sagittal parameters according to curve types, and assess related factors for postoperative aggravation of CSA.METHODSThe authors studied 318 consecutive patients with adolescent idiopathic scoliosis who underwent corrective surgery at a single center. Occiput–C2 and C2–7 lordosis, C2–7 sagittal vertical axis (SVA), T-1 slope, thoracic kyphosis, and lumbar sagittal profiles were measured preoperatively and postoperatively. Scoliosis Research Society Outcomes Questionnaire (SRS-22) scores were used as clinical outcomes. Each radiological parameter was compared preoperatively and postoperatively according to curve types (double major, single thoracic, and double thoracic curves). Patients were grouped based on preoperative CSA: the lordotic group (group L) and the kyphotic group (group K). Each radiological parameter was compared between the groups. Related factors for postoperative aggravation of CSA were assessed using multivariate logistic analysis.RESULTSOf the total number of patients studied, 67.0% (213 of 318) and 54.4% (173 of 318) showed cervical kyphotic alignment preoperatively and postoperatively, respectively. C2–7 lordosis increased (from −5.8° to −1.1°; p < 0.001) and C2–7 SVA decreased (from 24.2 to 20.0 mm; p < 0.001) postoperatively regardless of curve types. Although group K showed improvement in C2–7 lordosis (from −12.7° to −4.8°; p < 0.001), group L showed no difference (from 9.0° to 6.9°; p = 0.115) postoperatively. Clinical outcomes were not related to the degree of cervical kyphosis in this cohort. C2–7 lordosis (p < 0.001) and pelvic tilt (p = 0.019) were related to postoperative aggravation of CSA.CONCLUSIONSRegardless of the trend of improvement in CSA, many patients (54.4%) still showed cervical kyphotic alignment postoperatively. C2–7 lordosis and C2–7 SVA improved postoperatively in all curve types. However, postoperative changes in C2–7 lordosis showed different results based on preoperative CSA, which could be related to T-1 slope and thoracic kyphosis. However, clinical outcomes showed no difference based on CSA in this study cohort. Greater C2–7 lordosis and proximal thoracic curve preoperatively were risk factors for postoperative aggravation of CSA (p < 0.001 and p = 0.019, respectively).

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Section: Discussioncontrasting

confidence: 61%

Cervical sagittal alignment in patients with adolescent idiopathic scoliosis: is it corrected by surgery?

Cho¹,

Hwang²,

Choi³

et al. 2018

Journal of Neurosurgery: Pediatrics

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“…Wang et al reported that the cervical sagittal alignment in AIS patients was related with lumbar lordosis and particularly with thoracic kyphosis [7], . It has been reported in many studies that the cervical sagittal alignment correlate with health-related quality of life (HRQOL) in AIS patients [10] [11], and that suboptimal sagittal alignment after corrective surgery, such as decreased thoracic kyphosis (TK), is a possible cause of lumbar or cervical spinal degeneration and junctional malalignment [1].…”

Section: Introductionmentioning

confidence: 99%

Global Sagittal Alignment and Proximal Junctional Kyphosis in Adolescent Idiopathic Scoliosis

et al. 2019

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Study design: Case-Control Study Objectives: To analyse global sagittal alignment including the cranial center of mass (CCOM) and proximal junctional kyphosis (PJK) in Adolescent Idiopathic Scoliosis (AIS) patients treated with posterior instrumentation. Summary of background data: PJK plays an important role in the global sagittal alignment in AIS patients. Maintaining the head above the pelvis allows for a minimization of energy expense in ambulation and upright posture. Numerous studies have been performed to understand PJK phenomena in AIS patients. However, to our knowledge, no study performed on AIS patients included the head in the analysis of global sagittal alignment and PJK. Methods: This study included 85 AIS patients and 51 asymptomatic adolescents. Low-dose bi-planar X-rays were acquired for each subject preoperatively and at two years follow up. Two global sagittal alignment parameters were calculated, i.e. the angle between the vertical and the line joining the center of the bi-coxofemoral axis (HA) and either the most superior point of the dentiform apophysis of C2 (OD) or the cranial center of mass (CCOM). Results: Among normal adolescents, the average OD-HA and CCOM-HA angles were-2.3°±2° and-1.5°±1.8°, respectively. Among AIS patients the average OD-HA and CCOM-HA angles were respectively-2.3°±1.9° and-1.3°±1.8° preoperatively and-2.8°±1.7° and-1.9°±1.7° at the last follow up. 13% of the patients developed PJK postoperatively. Case-bycase analysis showed that adjusting the thoracic kyphosis and the compensations required to maintain this constant could provide explanatory elements. Conclusions: OD-HA and CCOM-HA angles remain almost constant among normal group and patients, pre-and post-operatively, whether PJK or non-PJK. Five patients without PJK and only one patient with PJK produced abnormal values relative to the asymptomatic subjects. Therefore, PJK could be a compensation mechanism, which allows for CCOM-HA and, to a lesser extent, OD-HA to remain invariant.

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“…Increasing sagittal offset has been shown to negatively affect SF-36 (Short Form-36 health survey) and NDI scores in patients who underwent posterior cervical fusion 5 and other studies have shown worse HRQOL scores with abnormal cervical alignment. 16,17 However, age-related normative cervical parameters in a North American population have not been established. Hardacker et al 4 reported on overall cervical lordosis in asymptomatic subjects but failed to include a comprehensive analysis of other cervical parameters and did not stratify subjects by age.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Aging on Cervical Parameters in a Normative North American Population

et al. 2016

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Study Design: Retrospective cohort study. Objectives: To investigate age-based changes in cervical alignment parameters in an asymptomatic population. Methods: Retrospective review of a prospective study of 118 asymptomatic subjects who underwent biplanar imaging with 3-dimensional capabilities. Demographic and health-related quality of life data was collected prior to imaging. Patients were stratified into 5 age groups: <35 years, 35-44 years, 45-54 years, 55-64 years, and !65 years. Radiographic measurements of the cervical spine and spinopelvic parameters were compared between age groups. The normal distribution of parameters was assessed followed by analysis of variance for comparison of variance between age groups. Results: C2-C7 lordosis, C0-C7 lordosis, and T1 slope demonstrated significant increases with age. C0-C7 lordosis was significantly less in subjects <35 years compared with !55 years. Significant differences in T1 slope were identified in patients <35 versus !65, 35-44 versus !65, and 45-54 versus !65 years. T1 slope demonstrated a positive correlation with age. Horizontal gaze parameters did not change linearly with age and mean averages of all age groups were within 10 of one another. Cervical kyphosis was present in approximately half of subjects who were <55 compared with approximately 10% of subjects !55 years. Differences in pelvic tilt, pelvic incidence-lumbar lordosis, and C7-S1 sagittal vertical axis were identified with age. Conclusions: C0-C7 lordosis, C2-C7 lordosis, and T1 slope demonstrate age-based changes while other cervical and horizontal gaze parameters remain relatively constant with age.

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Relationship between cervical sagittal alignment and health-related quality of life in adolescent idiopathic scoliosis

Cited by 58 publications

References 26 publications

Cervical sagittal alignment in patients with adolescent idiopathic scoliosis: is it corrected by surgery?

Cervical sagittal alignment in patients with adolescent idiopathic scoliosis: is it corrected by surgery?

Global Sagittal Alignment and Proximal Junctional Kyphosis in Adolescent Idiopathic Scoliosis

The Effect of Aging on Cervical Parameters in a Normative North American Population

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