The Sagittal Alignment of the Cervical Spine in Adolescent Idiopathic Scoliosis

Hilibrand, Alan S.; Tannenbaum, Darryl A.; Graziano, Gregory P.; Loder, Randall T.; Hensinger, Robert N.

doi:10.1097/01241398-199509000-00015

Cited by 137 publications

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“…The coronal and sagittal curvatures always coexist with axial modifications in vertebrae and disc. Hence, the structural thoracic coronal curves influenced the sagittal plane, consequently the cervical alignment as what Hilibrand et al [2] described.…”

Section: Analysis Of Various Spinal-pelvic Parameters and Lenke Classmentioning

confidence: 71%

“…Cochran et al [1] subjectively observed a cervical flattening or kyphosis in 49/95 patients without measurement. Hilibrand et al [2] reported a straight (lordosis \5°) or kyphotic cervical alignment in 34/39 patients (89 %) and concluded that patients with idiopathic scoliosis developed lordosis within thoracic spine and compensatory kyphosis within the cervical and lumbar segments. The development of the cervical lordosis is believed to begin in the infantile period following a child raising its head and the subsequent lordosis correlates with the larger anterior height in the sagittal plane of the intervertebral disc.…”

Section: Cervico-thoracic Curves In Different Groupsmentioning

confidence: 99%

“…Hilibrand et al [2] reported a result of 6°of kyphosis for cervical spine and a phenomenon that a hypo-kyphotic thoracic spine accompanies a kyphotic cervical spine before operation. Canavese et al [3] found that 34.4 % of patients with adolescent idiopathic scoliosis (AIS) had an average of 11°c ervical kyphosis, with their thoracic kyphosis \17°.…”

Section: Introductionmentioning

confidence: 99%

“…The previous researches provide us the fact that a hypokyphotic thoracic spine coexists with a kyphosis in cervical spine in idiopathic scoliosis [2,3]. However, overemphasis on the modification of isolated angles could render us neglect of their further association with the global spine alignment.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Analysis Of Various Spinal-pelvic Parameters and Lenke Classmentioning

confidence: 71%

Section: Cervico-thoracic Curves In Different Groupsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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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“…They noted there was no progression of cervical kyphosis if thoracic kyphosis remained under 20°after surgery. On the contrary, cervical kyphosis worsened, despite preservation of thoracolumbar sagittal contour, in patients with thoracic kyphosis of more than 20°after surgery they suggested that moderate thoracic hypokyphosis may predispose to cervical kyphosis and that correction of thoracic hypokyphosis did not necessarily lead to changes in the cervical sagittal plane [32].…”

Section: Discussionmentioning

confidence: 99%

Cervical spine sagittal alignment variations following posterior spinal fusion and instrumentation for adolescent idiopathic scoliosis

et al. 2011

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The aim of this study is to quantify the changes in the sagittal alignment of the cervical spine in patients with adolescent idiopathic scoliosis following posterior spinal fusion. Patients eligible for study inclusion included those with a diagnosis of mainly thoracic adolescent idiopathic scoliosis treated by means of posterior multisegmented hook and screw instrumentation. Pre and post-operative anterior-posterior and lateral radiographs of the entire spine were reviewed to assess the changes of cervical sagittal alignment. Thirty-two patients (3 boys, 29 girls) met the inclusion criteria for the study. The average pre-operative cervical sagittal alignment (CSA) was 4.0°± 12.3°(range -30°to 40°) of lordosis. Postoperatively, the average CSA was 1.7°± 11.4°(range -24°to 30°). After surgery, it was less than 20°in 27 patients (84.4%) and between 20°and 40°in 5 patients (15.6%). The results of the present study suggest that even if rod precontouring is performed and postoperative thoracic sagittal alignment is restored, improved or remains unchanged after significant correction of the deformity on the frontal plane, the inherent rigidity of the cervical spine limits changes in the CSA as the cervical spine becomes rigid over time.

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Sagittal wedging of intervertebral discs and vertebral bodies in the cervical spine and their associations with age, sex and cervical lordosis: A large‐scale morphological study

et al. 2021

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Many recent studies have focused on the functional and clinical importance of cervical lordosis. However, there is little accurate knowledge of the anatomical parameters that constitute cervical lordosis (i.e., the sagittal wedging angles of intervertebral discs and vertebral bodies) and their associations with age and sex. Standing lateral cervical radiographs of 1020 subjects (424 males, 596 females) with a mean age of 36.6 ± 17.0 years (range 7–95 years) were evaluated retrospectively. Cervical lordosis, the sum of intervertebral disc wedging angles from C2/C3 to C6/C7 and the sum of vertebral body wedging angles from C3 to C7 were measured. The sum of intervertebral disc wedging and the sum of vertebral body wedging were 20.6° ± 14.7° and −12.8° ± 10.3°, respectively. The sum of intervertebral disc wedging increased significantly with age and was significantly greater in males than females, whereas there was no sex‐related difference in the sum of vertebral body wedging. The sum of intervertebral disc wedging was negatively correlated with sum of vertebral body wedging. Wedging of discs contributed to C2–C7 cervical lordosis more significantly than wedging of vertebral bodies. There were moderate positive correlations between cervical lordosis and intervertebral disc wedging angles at C3/C4, C4/C5 and C5/C6; weak correlations were observed at C2/C3 and C6/C7. This study constitutes the largest currently available analysis comprehensively documenting the anatomical characteristics of sagittal wedging of intervertebral discs and vertebral bodies in the cervical spine. The findings could improve understanding of the internal architecture of cervical lordosis among clinicians.

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The Sagittal Alignment of the Cervical Spine in Adolescent Idiopathic Scoliosis

Cited by 137 publications

References 0 publications

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

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

Cervical spine sagittal alignment variations following posterior spinal fusion and instrumentation for adolescent idiopathic scoliosis

Sagittal wedging of intervertebral discs and vertebral bodies in the cervical spine and their associations with age, sex and cervical lordosis: A large‐scale morphological study

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