Reliabilities of and Correlations Among Five Standard Methods of Assessing the Sagittal Alignment of the Cervical Spine

Ohara, Akira; Miyamoto, Kei; Naganawa, Toshitaka; Matsumoto, Kazu; Shimizu, Katsuji

doi:10.1097/01.brs.0000240656.79060.18

Cited by 111 publications

(82 citation statements)

References 14 publications

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“…In a study by Ohara et al [73] and Nojiri et al [72] the C1-2 and Oc-C2 angle showed a significant inverse relation with the C2-7 angle suggesting that alignment changes of the upper and lower cervical spine are interrelated. We have corroborated these findings in a trauma population observing interdependence between the C1-2 and C7-T1 angles and the lordosis C2-7.…”

Section: Reconstruction and Maintenance Of Sagittal Alignmentmentioning

confidence: 91%

“…1). With the Harrison method the intra-and interobserver reliability was shown to be high [73] and a 2°error of measurement was to be expected [46]. Hence, sample size was calculated on the basis of a 2°effect change regarding geometrical measurements.…”

Section: Analysis Of Sagittal Alignmentmentioning

confidence: 99%

“…3 The sagittal tangent method for measurement of the absolute rotation angle C2-7 (ARA C2-C7) [73] and the measurement for the C1-2 angle Eur Spine J (2009) 18:630-653 633 the most extreme point of the VB in the rostral and caudal direction along the endplates (for superior and inferior endplates, respectively). Measurements were then made between the endplates at the anterior and posterior aspects of the VBs.…”

Section: Assessment Of Construct Geometrymentioning

confidence: 99%

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Mid- to long-term outcome of instrumented anterior cervical fusion for subaxial injuries

et al. 2009

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The management of patients with subaxial cervical injuries lacks consensus, particularly in regard to the decision which surgical approach or combination of approaches to use and which approach yields the best clinical outcome in the distinct injury. The trauma literature is replete with reports of surgical techniques, complications and gross outcome assessment in heterogeneous samples. However, data on functional and clinical outcome using validated outcome measures are scanty. Therefore, the authors performed a study on plated anterior cervical decompression and fusion for unstable subaxial injuries with focus on clinical outcome. For the purpose of a strongly homogenous subgroup of patients with subaxial injuries without spinal cord injuries, robust criteria were applied that were fulfilled by 28 patients out of an original series of 131 subaxial injuries. Twenty-six patients subjected to 1-and 2-level fusions without having spinal cord injury could be surveyed after a mean of 5.5 years (range 16-128 months). The cervical spine injury severity score averaged 9.6. Cross-sectional outcome assessment included validated outcome measures (Neck pain disability index, Cervical Spine Outcome Questionnaire, SF-36), the investigation of construct failure and successful surgical outcome were defined by strict criteria, the reconstruction and maintenance of local and total cervical lordosis, adjacent-segment degeneration and intervertebral motion, and the fusion-rate using an interobserver assessment. Selfrated clinical outcome was excellent or good in 81% of patients and moderate or poor in 19% that corresponded to the results of the validated outcome measures. Results of the NPDI averaged 12.4 ± 12.7% (0-40). With the SF-36 mean physical and mental component summary scores were 47.0 ± 9.8 (18.2-59.3) and 52.2 ± 12.4 (14.6-75.3), respectively. Using merely non-constrained plates, construct failure was observed in 31% of cases and loss of local lordosis, expressed as a mean injury angle of 14°, postoperative angle of -5.5°and follow-up angle of -1°, was significant. However, total cervical lordosis was within the limits of normalcy (-24.3°± 13.3) and fusion-rate was 88.5%. The progression of adjacent-level degeneration was shown to be significantly influenced by a decreased plate-to-disc-distance. Adjacent-level intervertebral motion was not altered due to the adjacent fusion, but reduced in Electronic supplementary material The online version of this article

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Section: Reconstruction and Maintenance Of Sagittal Alignmentmentioning

confidence: 91%

Section: Analysis Of Sagittal Alignmentmentioning

confidence: 99%

Section: Assessment Of Construct Geometrymentioning

confidence: 99%

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Mid- to long-term outcome of instrumented anterior cervical fusion for subaxial injuries

et al. 2009

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“…Two trained specialists conducted the marking procedure separately and the average value of their calculation was adopted for analysis. We categorized the cervical sagittal alignment into four types: lordosis, straight, sigmoid and kyphosis [9] (Fig. 4).…”

Section: Methodsmentioning

confidence: 99%

“…We thought the deformity correlates with their characteristics of global spine alignments both in sagittal and coronal planes. In this study, we defined cervical angle as the addition of the small angles, which could avoid possible inaccuracy of sagittal tangent method [9], which is to measure the angles between two lines designated parallel with posterior margins of C2 and C7. Though our calculation is far more complicated than the traditional measurement, it is likely to be more precise to reflect the authentic overall alignment of cervical spine than the conventional one.…”

Section: Cervico-thoracic Curves In Different Groupsmentioning

confidence: 99%

Analysis of the cervical spine sagittal alignment in young idiopathic scoliosis: a morphological classification of 120 cases

Silvestre

Mouton

et al. 2013

Eur Spine J

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Purpose To analyze the relationship between the cervical spine and global spinal-pelvic alignment in young patients with idiopathic scoliosis based on a morphological classification, and to postulate the hypothesis that cervical kyphosis is a part of cervico-thoracic kyphosis in them. Methods 120 young patients with idiopathic scoliosis were recruited retrospectively between 2006 and 2011. The following values were measured and calculated: cervical angles (CA), cervico-thoracic angles (CTA), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), spinal sacral angle (SSA), hip to C7/hip to sacrum, thoracic kyphosis (TK), lumbar lordosis (LL), Roussouly sagittal classification, Lenke Type Curve and Lumbar Modifier. The cervical curves were classified as lordosis, straight, sigmoid and kyphosis. They were categorized into four groups as cervical non-kyphosis group (CNK Group), cervical kyphosis group (CK Group), cervical-middle-thoracic kyphosis group (CMTK Group), and cervical-lower-thoracic kyphosis group (CLTK Group) according to their morphological characters of sagittal alignments. All parameters were compared and analyzed among groups. Results The incidence of cervical kyphosis was 40 % (48/ 120). The CA and the CTA were in significant correlation (r = 0.854, P = 0.00). The cervical spine alignments were revealed to be significantly different among groups (r = 85.04, P = 0.00). Significant differences among groups in CA, CTA and TK were also detected. A strong correlation between the group type and Lenke Lumbar Modifier was still seen (P \ 0.05). Fisher's exact test revealed that the individual vertebral body kyphosis and wedging were directly related to the overall cervical kyphosis (P = 0.00, respectively). Conclusion The cervical kyphosis is correlated with global sagittal alignment, and is a part of cervico-thoracic sagittal deformity in young patients with idiopathic scoliosis. Despite the deformity in cervical alignment, the global spine could still be well-balanced with spontaneous adjustment. The correlation between our grouping based on the morphological characteristics of the sagittal alignments and Lenke Lumbar Modifier suggests that the coupled motion principle be appropriate to explain the modifications both in coronal and sagittal planes.

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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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Reliabilities of and Correlations Among Five Standard Methods of Assessing the Sagittal Alignment of the Cervical Spine

Abstract: The correlations among the CCL, C1-C7 Cobb, C2-C7 Cobb, sagittal tangent, and Ishihara methods are strong when lordosis is retained; otherwise, they are moderate to poor. In the kyphotic group, C1-C7 Cobb has no significant correlation with the other 4 methods.

Cited by 111 publications

References 14 publications

Mid- to long-term outcome of instrumented anterior cervical fusion for subaxial injuries

Mid- to long-term outcome of instrumented anterior cervical fusion for subaxial injuries

Analysis of the cervical spine sagittal alignment in young idiopathic scoliosis: a morphological classification of 120 cases

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

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