Relationship Between T1 Slope and Cervical Alignment Following Multilevel Posterior Cervical Fusion Surgery

Hyun, Seung-Jae; Kim, Ki-Jeong; Jahng, Tae-Ahn; Kim, Hyun-Jib

doi:10.1097/brs.0000000000001264

Cited by 139 publications

(123 citation statements)

References 22 publications

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“…19 Even though the correlation between such radiographic parameters of cervical sagittal alignment with quality of life and postoperative outcomes in patients submitted to surgical treatment is well-established, 15,20,21 there is a scarcity of evidence in the literature of any correlation between cervical sagittal parameters and loss of quality of life or functional disability in patients in conservative treatment. Thus, the objective of this study is to evaluate and correlate radiographic parameters of cervical sagittal alignment with quality of life and functional disability indicators in patients with cervical spondylosis in a conservative outpatient treatment regimen who are not candidates for surgical treatment.…”

Section: Introductionmentioning

confidence: 99%

Correlation Between Cervical Sagittal Alignment and Functional Capacity in Cervical Spondylosis

2017

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Objective: To correlate the radiographic parameters of sagittal cervical alignment with quality of life and functional capacity in patients with cervical spondylosis under conservative treatment. Methods: This is an observational and prospective study in patients with cervical spondylosis under conservative treatment and without indication for surgery. The 52 patients included were divided into three groups: axial pain, radiculopathy, and cervical myelopathy. The radiographic parameters considered were cervical lordosis (CL), cervical sagittal vertical axis (CSVA), T1 slope (TS) and the discrepancy between TS and CL (TS-CL). Quality of life and functional capacity were evaluated by the Neck Disability Index (NDI) questionnaire. Pain was assessed by the Visual Analogue Scale (VAS). The correlation between the radiographic parameters and the clinical scores was evaluated by the Pearson correlations coefficient. Results: There was no difference in cervical radiographic parameters between the three groups. In the total of the sample, the mean value of the CSVA was 17.8 o (±8.3 o ), CL, 22.4° (± 8.8°); TS, 29.3° (±6.6°), and TS-CL, 7.0° (±7.4°). Significant inverse correlation (r= -0.3, p=0.039) was observed between NDI and CL, but there was no significant correlation between CL and VAS. CSVA (p=0.541), TS (p=0.287) and TS-CL (p=0.287) had no significantly correlated with NDI or VAS. Conclusion: Considering patients with cervical spondylosis not candidates for surgery, the only sagittal parameter that correlated with functional capacity was LC. In these patients, the correlation between cervical alignment and quality of life needs to be better characterized.Keywords: Spondylosis; Neck pain; Lordosis; Postural balance; Quality of life. (± 8,3°); de LC,22,4° (± 8,8 °); del AIT1,29,3° (± 6,7,0° (± 7,4°). Se observó una correlación inversa significativa (r = -0,3, p = 0,039) entre NDI y LC, pero no hubo correlación significativa entre LC y EVA. EVSC (p = 0,541), AIT1 (p = 0,287) RESUMO

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Section: Introductionmentioning

confidence: 99%

Correlation Between Cervical Sagittal Alignment and Functional Capacity in Cervical Spondylosis

2017

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“…Previous studies has also proved the T1 slope is a parameter that represents the angle, whereas C2-7SVA represents global sagittal alignment. Hyun et al and Tang et al considered C2-7 SVA was the best indicator of cervical malalignment, which significantly impacted by the T1 slope and cervical curvature [24,25] .…”

Section: Discussionmentioning

confidence: 98%

“…C2-7SVA is thought to be another important indicators of cervical sagittal balance [20,21] . It is well known that the threshold for cervical imbalance is C2-7SVA ≥ 40 mm.…”

Section: Discussionmentioning

confidence: 99%

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The impact of cervical sagittal parameters on axial neck pain in patients with cervical kyphosis

Zhang

Shen

2020

Preprint

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Background:Cervical sagittal alignment is closely related with cervical disc degeneration and impacts the spinal function and quality of life, especially for cervical kyphosis (CK). The purpose of this study was to evaluate the influence of cervical sagittal parameters on the axial neck pain (ANP) in patients with CK.Methods: A retrospective analysis was performed of data from 263 patients who underwent to the authors' department of this institution between January 2012 and December 2018. Radiographic evaluations were performed at authors' department, including CK types, C2-7 sagittal vertical axis (SVA), thoracic inlet angle (TIA), T1 slope, neck tilt (NT), cranial tilt and cervical tilt. Sagittal alignment of the cervical spine was classified into 2 types: global and regional type. Multivariate logistic regression analysis was performed to evaluate these parameters as the risk factors for ANP.Results: Patients in this study were divided into 2 groups according to ANP. There were 92 patients in ANP group and 171 patients in Non-ANP group. There was no significant difference in age (P=0.196), gender (P=0.516), TIA(P=0.139), NT (P=0.676), CK types (P=0.533), cranial tilt (P=0.332), cervical tilt (P=0.585) and cervical disc degeneration (P=0.695) between the two groups. T1 slope, C2-7 SVA in the ANP group was significantly higher than in the Non-ANP group (P < 0.05). After multivariate logistic regression analysis, C2-7 SVA (P=0.003, OR 2.318, 95% CI 1.373-4.651) and T1 slope (P=0.028, OR 2.563, 95% CI 1.186-4.669) were the two risk factors for the ANP.Conclusions: Based on this study, cervical sagittal parameters have a significant effect on the happening of axial neck pain in patients with CK. A higher T1 slope and larger C2-7 SVA are closely lead to the development of neck pain. BackgroundCervical sagittal imbalance is the one of the main reasons for decreased intervertebral disc height, further leads to the cervical degenerative disease [1, 2] . The misalignment exacerbates more distribution of the load on the intervertebral disc and posterior joints, accelerates the progression of spinal degenerative diseases during the range of motion. However, there is limited data exploring the relationship between cervical sagittal alignment and axial neck pain(ANP). JL carried out the manuscript preparation and experimental design, DZ conducted patient visits and statistical analysis of the data. JL and DZ carried out the statistical analysis of the data.YS revised the manuscript critically for important intellectual content and gave final approval of the version to be published.All authors read and approved the final version of this manuscript. Authors' information

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“…The required degree of cervical lordosis post-operatively appears to be closely linked to the slope of the T1 segment, which is widely accepted as a marker for other global parameters [49, 50], but many compensatory changes occur that might lead to asymptomatic conditions [51]. We have not measured the T1-slope in our patients.…”

Section: Discussionmentioning

confidence: 99%

The influence of sagittal profile alteration and final lordosis on the clinical outcome of cervical spondylotic myelopathy. A Delta-Omega-analysis

Koeppen¹,

Piepenbrock²,

Kroppenstedt³

et al. 2017

PLoS ONE

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PurposeDecompression and maintaining or restoring a cervical lordosis are major goals in the surgical treatment of cervical spondylotic myelopathy (CSM). Numerous studies support the assumption that cervical lordosis is a key factor for neurological recovery and pain reduction. However, even kyphotic patients can be asymptomatic. The balance of the spine is subject of an increasing number of publications. The main purpose of the study was to evaluate the validity of lordotic alignment on the course of CSM and to set this parameter in context with well-validated tools, namely the modified Japanese Orthopaedic Association scoring system (mJOAS) and the visual analogue scale (VAS), to predict and measure the clinical outcome after surgery.MethodsThis is a retrospective study with prospectively collected data of a heterogeneous cohort. The authors analyzed the records of 102 patients suffering from CSM that underwent decompressive surgery and instrumentation. Clinical outcome was assessed by using the mJOAS, VAS and Odom’s criteria. The radiological analysis involved comparison of pre- and postoperative radiographs. The patients were divided into subgroups to be able to compare the influence of various amounts of correction (3 Delta-groups: <0°, 1–7° and ≥8°) and final lordosis (4 Omega-groups: 0–7°, 8–14°, 15–21°, ≥22°).Results219 levels were fused in 102 patients. Surgery improved the clinical outcome of all groups significantly. A lordotic profile was achieved in all analyzed groups. Patients that showed small lordosis after surgery (<8°) did not have an inferior clinical outcome compared to patients with larger cervical lordosis (>14°). The comparison of Odom’s criteria showed that preoperatively kyphotic patients benefitted more from surgery than lordotic patients (p = 0.029), but no differences could be seen comparing neck pain and neurological improvement. The improvement of pain and neurological impairment measured by VAS and mJOAS supports the statistical impact and validity of the data despite comparatively small numbers of patients. The lack of postoperative kyphosis is a major limitation of the study to encompass the impact of sagittal alignment on clinical outcome.ConclusionsDecompression and stabilization appear to be key elements of surgical treatment of CSM. While the achievement of cervical lordosis remains a major goal of surgery, clinical improvement is not hindered in patients who show small lordosis. However, kyphosis should be eliminated in symptomatic patients. The terms “balance” and “physiologic lordosis” remain complex entities without clear definition. To check the results of our study controlled randomized trials to validate and determine the exact role of cervical balance on the course of CSM would be helpful.

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Relationship Between T1 Slope and Cervical Alignment Following Multilevel Posterior Cervical Fusion Surgery

Abstract: 3.

Cited by 139 publications

References 22 publications

Correlation Between Cervical Sagittal Alignment and Functional Capacity in Cervical Spondylosis

Correlation Between Cervical Sagittal Alignment and Functional Capacity in Cervical Spondylosis

The impact of cervical sagittal parameters on axial neck pain in patients with cervical kyphosis

The influence of sagittal profile alteration and final lordosis on the clinical outcome of cervical spondylotic myelopathy. A Delta-Omega-analysis

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