Small C7–T1 lordotic angle and muscle degeneration at C7 level were independent radiological characteristics of patients with cervical imbalance: a propensity score-matched analysis

Tamai, Katsuto; Romanu, Joshua; Grisdela, Phillip; Paholpak, Permsak; Zheng, Pengfei; Nakamura, Hiroaki; Buser, Zorica; Wang, Jeffrey C.

doi:10.1016/j.spinee.2018.01.012

Cited by 16 publications

(8 citation statements)

References 30 publications

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“…Based on the previous literature on asymptomatic populations, the normal segmental lordotic angles are as follows: − 1.0° at C5/6, − 4.5° at C6/7, − 4.0° at C7/T1, and 0° at T1/ T2 [17][18][19]. According to the estimated segmental lordosis predicted from the regression models, the ISPD values that we recommend would achieve these normative values (Table 5).…”

Section: Discussionmentioning

confidence: 88%

Inter-spinous process distance: a novel parameter predicting segmental lordosis during posterior cervical spine deformity surgery

2019

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Purpose To investigate the normative value of distance between the spinous processes (inter-spinous process distance, ISPD), correlations between patients' demographics and ISPD, and determine cutoff ISPD values that result in segmental lordosis in posterior cervical-thoracic arthrodesis with instrumentation. Methods We reviewed patients with visible lower cervical and cervicothoracic spinous processes (C5-T2) on dynamic X-rays. Radiographic measurements included segmental Cobb angles (S-Cobb) and ISPD, defined as the distance between midpoints of the spinous processes. Correlations between patient demographics and ISPD were evaluated. In addition, the cutoff ISPD values that predict segmental lordosis (S-Cobb < 0°) were determined using the receiver operating characteristics (ROC) curve and linear regression model. Results We evaluated a total of 153 films on 51 patients. The mean ISPDs in neutral position were 16.0, 20.7, 23.2, and 26.0 mm at C5/6, C6/7, C7/T1, and T1/T2, respectively There were no or only weak correlations between ISPD and age, race, height, body weight, and BMI. We observed significant difference between male and female ISPDs at C7/T1 and T1/T2 (P < 0.05). The ISPDs had moderate/strong correlations with S-Cobb at each segment (− 0.450 ≤ r ≤ − 0.705). Based on the ROC curves, the following cutoff values of ISPD provided 100% positive predictive value for segmental lordosis: < 10 mm at C5-6; < 15 mm at each level from C6 to T2. Conclusion ISPD is a simple and useful parameter that correlates with the segmental Cobb angle. During posterior cervical deformity surgery, surgeons can intraoperatively predict adequate segmental lordosis by utilizing the vertebral level specific cutoff values of ISPD.

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Section: Discussionmentioning

confidence: 88%

Inter-spinous process distance: a novel parameter predicting segmental lordosis during posterior cervical spine deformity surgery

2019

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“…It shows a close correlation with thoracic kyphosis, TIA, and C2-7 SVA [ 21 ]. C2-7SVA is believed to be another important indicator of cervical sagittal balance [ 22 , 23 ]. The threshold for cervical imbalance is C2-7SVA ≥ 40 mm [ 24 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

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

Zhang

Shen

2020

J Orthop Surg Res

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Background Cervical sagittal alignment (CSA) is closely related with cervical disk degeneration and impacts the spinal function, especially in the setting of cervical kyphosis (CK). In this study, we evaluated the influence of cervical sagittal parameters on the development of axial neck pain (ANP) in patients with CK. Methods Data pertaining to 263 patients with CK who visited the outpatient department of our hospital between January 2012 and December 2018 were retrospective analyzed. The most common symptoms of ANP were neck pain, stiffness, or dullness. Visual analog scale (VAS) was used to evaluate ANP. The following radiographic parameters were evaluated: 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 CK was classified into 2 types: global and regional type. Multivariate logistic regression analysis was performed to identify risk factors for ANP. Results Patients who complained of ANP were categorized as ANP group (VAS score ≥ 3; n = 92), while those without ANP were categorized as non-ANP group (VAS score < 3; n = 171). There was no significant between-group difference with respect to age (P = 0.196), gender (P = 0.516), TIA (P = 0.139), NT (P = 0.676), CK type (P = 0.533), cranial tilt (P = 0.332), cervical tilt (P = 0.585), or cervical disk degeneration (P = 0.695). The T1 slope and C2-7 SVA in the ANP group were significantly greater than that in the non-ANP group (P < 0.05). On multivariate logistic regression, C2-7 SVA [ odds ratio (OR) 2.318, 95% confidence interval 1.373–4.651, P = 0.003) and T1 slope (OR 2.563, 95% CI 1.186–4.669, P = 0.028) were identified as risk factors for ANP. Conclusions Our findings suggest a significant effect of cervical sagittal parameters on the occurrence of ANP in patients with CK. Greater T1 slope and larger C2-7 SVA may lead to the development of neck pain.

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“…It shows a close correlation with thoracic kyphosis, TIA, and C2-7 SVA [26] . C2-7SVA is believed to be another important indicator of cervical sagittal balance [20,21] . The threshold for cervical imbalance is C2-7SVA≥40 mm.…”

Section: Discussionmentioning

confidence: 99%

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 (CSA) is closely related with cervical disc degeneration and impacts the spinal function, especially in the setting of cervical kyphosis (CK). In this study, we evaluated the influence of cervical sagittal parameters on the development of axial neck pain (ANP) in patients with CK.Methods: Data pertaining to 263 patients with CK who visited the outpatient department of our hospital between January 2012 and December 2018 were retrospective analyzed. The most common symptoms of ANP were neck pain, stiffness, or dullness. Visual analogue scale (VAS) was used to evaluate ANP. The following radiographic parameters were evaluated: 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 CK was classified into 2 types: global and regional type. Multivariate logistic regression analysis was performed to identify risk factors for ANP.Results: Patients who complained of ANP were categorized as ANP group (VAS score≥3; n=92), while those without ANP were categorized as non-ANP group (VAS score<3; n=171). There was no significant between-group difference with respect to age (P=0.196), gender (P=0.516), TIA (P=0.139), NT (P=0.676), CK type (P=0.533), cranial tilt (P=0.332), cervical tilt (P=0.585), or cervical disc degeneration (P=0.695). The T1 slope and C2-7 SVA in the ANP group was significantly greater than that in the non-ANP group (P < 0.05). On multivariate logistic regression, C2-7 SVA [odds ratio (OR) 2.318, 95% confidence interval 1.373–4.651, P=0.003) and T1 slope (OR 2.563, 95% CI 1.186–4.669, P=0.028) were identified as risk factors for ANP.Conclusions: Our findings suggest a significant effect of cervical sagittal parameters on the occurrence of ANP in patients with CK. Greater T1 slope and larger C2-7 SVA may lead to the development of neck pain.

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Small C7–T1 lordotic angle and muscle degeneration at C7 level were independent radiological characteristics of patients with cervical imbalance: a propensity score-matched analysis

Cited by 16 publications

References 30 publications

Inter-spinous process distance: a novel parameter predicting segmental lordosis during posterior cervical spine deformity surgery

Inter-spinous process distance: a novel parameter predicting segmental lordosis during posterior cervical spine deformity surgery

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

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

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