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Miyake K, Fujishiro T, Yamamoto Y, Usami Y, Hayama S, Nakaya Y, Neo M. Influence of cranium orientation on cervical sagittal alignment during radiographic examination: a radiographic analysis. Spine J 2024:S1529-9430(24)00928-8. [PMID: 39147140 DOI: 10.1016/j.spinee.2024.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 06/24/2024] [Accepted: 08/09/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND CONTEXT During the radiographic examination, the cranium orientation varies not only individually but also within the same subject, in different imaging sessions. Knowing how changes in the orientation of the cranium influences cervical sagittal alignment during the radiographic examination of the cervical spine can aid clinicians in the accurate evaluation for cervical sagittal alignment in clinical practice. PURPOSE To radiographically examine the influence of cranium orientation on cervical sagittal alignment during radiographic examination in an asymptomatic cohort. STUDY DESIGN A prospective radiographic study. PATIENT SAMPLE Eighty asymptomatic volunteers (mean age, 40.4 years; 50.0% male) were enrolled. OUTCOME MEASURES Cervical sagittal parameters including the regional slope (C1 slope, C2 slope, C5 slope, C7 slope, and T1 slope), Cobb angle (O-C1 angle, C1-C2 angle, C2-C5 angle, C5-C7 angle, and C7-T1 angle), and cranial/cervical offset (sella turcica tilt [ST tilt] and C2 tilt). METHODS In all participants, standing lateral radiographs of the cervical spine were taken in three forward-gazing positions: anteverted-cranium (AC) position; neutral-cranium (NC) position; and retroverted-cranium (RC) position. Cervical sagittal parameters, including the regional slope, Cobb angle, and cranial/cervical offset, in these three positions were statistically compared. RESULTS The C1 and C2 slopes were anteverted and retroverted in the AC and RC positions, respectively, compared to those in the NC position. The C5 slope, C7 slope, and T1 slope were constant among the three positions. In O-C2 and C2-C5, statistically significant differences in the regional Cobb angles were identified among the three positions; however, there were no significant differences in the C5-C7 or C7-T1 segments. Cranial and cervical offsets of ST tilt and C2 tilt increased and decreased when the cranium was anteverted and retroverted, respectively. CONCLUSIONS The current study suggests that the adjustment of the cranium orientation when taking cervical spine radiographs is mainly controlled at the upper cervical spine of the O-C2 segment in an asymptomatic cohort. On radiograph, alignment in the upper cervical segment of O-C2 changes; accordingly, the middle cervical segment of C2-C5 can change during the adjustment of cranium orientation. However, alignment in the lower cervical segment of C5-C7 and the cervicothoracic junction of C7-T1 remains constant. Further, cranial/cervical offset increases and decreases when the cranium is anteverted and retroverted, respectively. Our results can help the accurate evaluation of cervical sagittal alignment on plain radiographs in clinical practice.
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Affiliation(s)
- Katsuhiro Miyake
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University
| | - Takashi Fujishiro
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University.
| | - Yuki Yamamoto
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University
| | - Yoshitada Usami
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University
| | - Sachio Hayama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University
| | - Yoshiharu Nakaya
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University
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Henao Romero S, Sierra Peña JA, Diaz Orduz RC, Berbeo-Calderon ME. Horizontal Gaze Assessment: An Extensive Narrative Review. World Neurosurg 2024; 187:e1011-e1016. [PMID: 38750886 DOI: 10.1016/j.wneu.2024.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 05/07/2024] [Indexed: 06/09/2024]
Abstract
OBJECTIVE Bipedalism was a significant milestone in the evolutionary development of Homo sapiens sapiens, influencing neocortical evolution and subsequent behavioral changes. Coordinated visual and sensory inputs are crucial for posture, environmental interaction, and surgical planning, with horizontal gaze being a pivotal parameter. This narrative review aims to explore various geometric measures used to assess horizontal gaze in patients, highlighting their applications in surgical planning. METHODS A literature review was conducted in indexed databases using Mesh terms like "Cervical Vertebrae" and "Visual Fields" along with keywords such as "horizontal gaze" and "sagittal spine parameters." Among 477 initially identified articles, 41 were selected for inclusion after rigorous filtering. RESULTS The most recognized method for assessing horizontal gaze is the Chin Brow Vertical Angle (CBVA), initially described in patients with ankylosing spondylitis. Clinical photography is employed as a tool for CBVA calculation, while other measures like McGregor slope and Slope of the Line of Sight have been considered as alternatives to CBVA. Each method presents its unique advantages and limitations. CONCLUSIONS This review highlights the need for further research into horizontal gaze measurement methods. Developing novel approaches to determine horizontal gaze can significantly enhance surgical planning and, consequently, improve patient outcomes. The ongoing exploration of these geometric measures offers promising prospects for advancing the field and optimizing patient care.
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Affiliation(s)
- Sara Henao Romero
- Department of Neurosurgery, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia; Neurosurgery research seedbed, Pontificia Universidad Javeriana, Bogotá, Colombia.
| | | | - Roberto Carlos Diaz Orduz
- Department of Neurosurgery, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
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Kim DH, Hong JT, Hur JW, Kim IS, Lee HJ, Lee JB. Clinical and Radiological Outcomes in C2 Recapping Laminoplasty for the Pathologies in the Upper Cervical Spine. Neurospine 2024; 21:565-574. [PMID: 38955529 PMCID: PMC11224761 DOI: 10.14245/ns.2347270.635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/31/2024] [Accepted: 02/09/2024] [Indexed: 07/04/2024] Open
Abstract
OBJECTIVE To evaluate C2 muscle preservation effect and the radiological and clinical outcomes after C2 recapping laminoplasty. METHODS Fourteen consecutive patients who underwent C2 recapping laminoplasty around C1-2 level were enrolled. To evaluate muscle preservation effect, the authors conducted a morphological measurement of extensor muscles between the operated and nonoperated side. Two surgeons measured the cross-sectional area (CSA) of obliquus capitis inferior (OCI) and semispinalis cervicis (SSC) muscle before and after surgery to determine atrophy rates (ARs). Additionally, we examined range of motion (ROM), sagittal vertical axis (SVA), neck visual analogue scale (VAS), Neck Disability Index (NDI), and Japanese Orthopaedic Association (JOA) score to assess potential changes in alignment and consequent clinical outcomes following posterior cervical surgery. RESULTS We measured the CSA of OCI and SSC before surgery, and at 6 and 12 months postoperatively. Based on these measurements, the AR of the nonoperated SSC was 0.1% ± 8.5%, the AR of the operated OCI was 2.0% ± 7.2%, and the AR of the nonoperated OCI was -0.7% ± 5.1% at the 12 months after surgery. However, the AR of the operated side's SSC was 11.2% ± 12.5%, which is a relatively higher value than other measurements. Despite the atrophic change of SSC on the operated side, there were no prominent changes observed in SVA, C0-2 ROM, and C2-7 ROM between preoperative and 12 months postoperative measurements, which were 11.8 ± 10.9 mm, 16.3° ± 5.9°, and 48.7° ± 7.7° preoperatively, and 14.1 ± 11.6 mm, 16.1° ± 7.2°, and 44.0° ± 10.3° at 12 months postoperative, respectively. Improvement was also noted in VAS, NDI, and JOA scores after surgery with JOA recovery rate of 77.3% ± 29.6%. CONCLUSION C2 recapping laminoplasty could be a useful tool for addressing pathologies around the upper cervical spine, potentially mitigating muscle atrophy and reducing postoperative neck pain, while maintaining sagittal alignment and ROM.
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Affiliation(s)
- Dong Hun Kim
- Department of Neurosurgery, Eunpyeong St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jae Taek Hong
- Department of Neurosurgery, Eunpyeong St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jung Woo Hur
- Department of Neurosurgery, Eunpyeong St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Il Sup Kim
- Department of Neurosurgery, St. Vincent Hospital, The Catholic University of Korea, Suwon, Korea
| | - Ho Jin Lee
- Department of Neurosurgery, St. Vincent Hospital, The Catholic University of Korea, Suwon, Korea
| | - Jong Beom Lee
- Department of Neurosurgery, Chungbuk National University Hospital, Cheongju, Korea
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Haas JW, Oakley PA, Betz JW, Miller JE, Jaeger JO, Moustafa IM, Harrison DE. Sagittal Full-Spine vs. Sectional Cervical Lateral Radiographs: Are the Measurements of Cervical Alignment Interchangeable? J Clin Med 2024; 13:2502. [PMID: 38731030 PMCID: PMC11084776 DOI: 10.3390/jcm13092502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/18/2024] [Accepted: 04/18/2024] [Indexed: 05/13/2024] Open
Abstract
(1) Background: This study assessed the relationship between cervical spine parameters taken on standing full-spine lateral radiographic images compared to sectional lateral cervical radiographs. (2) Methods: Full-spine (FS) and sectional lateral cervical (LC) radiographs from four spine treatment facilities across the USA retrospectively provided data collected on 220 persons to assess the comparison of three sagittal cervical radiographic measurements between the two views. The measures included cervical lordosis using the absolute rotation angle from C2-C7, sagittal cervical translation of C2-C7, and atlas plane angle to horizontal. Linear correlation and R2 models were used for statistical comparison of the measures for the two views. (3) Results: The mean values of the three measurements were statistically different from each other: C2-C7 translation (FS = 19.84 ± 11.98 vs. LC = 21.18 ± 11.8), C2-C7 lordosis (FS = -15.3 ± 14.63 vs. LC = -18.32 ± 13.16), and atlas plane (FS = -19.99 ± 8.88 vs. LC = -22.56 ± 8.93), where all values were p < 0.001. Weak-to-moderate-to-strong correlations existed between the full-spine and sectional lateral cervical radiographic variables. The R2 values varied based on the measurement were R2 = 0.768 (p < 0.001) for sagittal cervical translation of C2-C7 (strong), R2 = 0.613 (p < 0.001) for the absolute rotation angle C2-C7 (moderate), and R2 = 0.406 (p < 0.001) for the atlas plane line (weak). Though a linear correlation was identified, there were consistent intra-person differences between the measurements on the full spine versus sectional lateral cervical radiographic views, where the full-spine view consistently underestimated the magnitude of the variables. (4) Conclusion: Key sagittal cervical radiographic measurements on the full spine versus sectional lateral cervical radiographic views show striking intra-person differences. The findings of this study confirm that full spine versus sectional lateral cervical radiographic views provide different biomechanical magnitudes of cervical sagittal alignment, and caution should be exercised by health care providers as these are not interchangeable. We recommend the LC view for measurement of cervical sagittal alignment variables.
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Affiliation(s)
- Jason W. Haas
- CBP NonProfit, Inc., Eagle, ID 83616, USA; (J.W.H.); (J.W.B.); (J.E.M.); (J.O.J.)
| | - Paul A. Oakley
- Kinesiology and Health Science, York University, Toronto, ON M3J 1P3, Canada;
| | - Joseph W. Betz
- CBP NonProfit, Inc., Eagle, ID 83616, USA; (J.W.H.); (J.W.B.); (J.E.M.); (J.O.J.)
- Private Practice, Boise, ID 83709, USA
| | - Jason E. Miller
- CBP NonProfit, Inc., Eagle, ID 83616, USA; (J.W.H.); (J.W.B.); (J.E.M.); (J.O.J.)
- Private Practice, Lakewood, CO 80226, USA
| | - Jason O. Jaeger
- CBP NonProfit, Inc., Eagle, ID 83616, USA; (J.W.H.); (J.W.B.); (J.E.M.); (J.O.J.)
- Community Based Internship Program, Associate Faculty, Southern California University of Health Sciences, Whittier, CA 90604, USA
| | - Ibrahim M. Moustafa
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
- Neuromusculoskeletal Rehabilitation Research Group, RIMHS–Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Deed E. Harrison
- CBP NonProfit, Inc., Eagle, ID 83616, USA; (J.W.H.); (J.W.B.); (J.E.M.); (J.O.J.)
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Cho Y, Jo DJ, Hyun SJ, Park JH, Yang NR. From the Spinopelvic Parameters to Global Alignment and Proportion Scores in Adult Spinal Deformity. Neurospine 2023; 20:467-477. [PMID: 37401065 PMCID: PMC10323335 DOI: 10.14245/ns.2346374.187] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/16/2023] [Accepted: 05/16/2023] [Indexed: 07/05/2023] Open
Abstract
In the last 20 years, sagittal alignment and balance of the spine have become one of the most important issues in the field of spine surgery. Recent studies emphasize that sagittal balance and alignment are more important for health-related quality of life. The understanding of normal and abnormal sagittal alignment of the spine is necessary for the diagnosis and appropriate treatment of adult spinal deformity (ASD), and we will discuss the currently used classification of ASD, the parameters of sagittal alignment that are essential for the diagnosis of spinal deformity, compensatory actions to maintain sagittal balance, and the relationship between sagittal alignment and clinical symptoms. Furthermore, we will also discuss the recently introduced Global Alignment and Proportion scores. The Korean Spinal Deformity Society is publishing a series of review articles on spinal deformities to help spine surgeons better understand spinal deformities.
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Affiliation(s)
- Yongjae Cho
- Department of Neurosurgery, Ewha Womans University, School of Medicine, Seoul, Korea
| | - Dae Jean Jo
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | - Seung-Jae Hyun
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jin Hoon Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Na Rae Yang
- Department of Neurosurgery, Ewha Womans University College of Medicine, Seoul, Korea
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Analysis of Parameters That Can Predict the Cervical Sagittal Vertical Axis in Cervical Fusion Surgery. World Neurosurg 2022; 164:e1071-e1077. [PMID: 35636665 DOI: 10.1016/j.wneu.2022.05.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/20/2022] [Accepted: 05/21/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The absolute value of the cervical sagittal parameters cannot be guaranteed with certainty on all follow-up cervical radiographs. With the assumption that neck posture changes can occur at any time at each follow-up radiographic session, we examined whether the sagittal parameters change meaningfully and identified the factors most closely related to the C2-C7 sagittal vertical axis (SVA). METHODS We enrolled 200 patients who had undergone either anterior cervical fusion (n = 100) or posterior cervical fusion (n = 100). The craniovertebral angle (CVA), mandible angle (MA), occipital slope (Os), C2 slope (C2s), C7 slope (C7s), and C2-C7 SVA were measured on 2 different follow-up radiographs after surgery. The C2-C7 angle (C2-C7A) and changes (Δ) in the sagittal parameters between the 2 radiographs were then calculated. RESULTS The ΔC2s and ΔCVA showed a very strong correlation with the ΔC2-C7 SVA (r = |0.70-0.93|). An independent t test showed a statistically significant difference for multiple sagittal parameters (i.e., ΔMA, ΔOs, ΔC2s, ΔC7s, and ΔCVA) between the large and small ΔC2-C7 SVA groups. In contrast, the change in the C2-C7A was without statistical significance. A stepwise multivariate regression analysis revealed a high adjusted R2 value (0.841) between the ΔC2-C7 SVA and 2 parameters (standardized coefficient: ΔCVA, -0.563; ΔC2s, -0.398). CONCLUSIONS During cervical fusion surgery, the CVA was the most predictable parameter reflecting the C2-C7 SVA in various analyses. The upper cervical parameters (Os and C2s) provided more explanatory power regarding the C2-C7 SVA changes than did the lower cervical parameter (C7s) or the presence of cervical lordosis (C2-C7A).
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Lee HJ, You ST, Sung JH, Kim IS, Hong JT. Analyzing the Significance of T1 Slope minus Cervical Lordosis in Patients with Anterior Cervical Discectomy and Fusion Surgery. J Korean Neurosurg Soc 2021; 64:913-921. [PMID: 34749484 PMCID: PMC8590907 DOI: 10.3340/jkns.2021.0011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/03/2021] [Indexed: 11/27/2022] Open
Abstract
Objective Accurate measurement of T1 slope (a component of T1s minus cervical lordosis [CL]) is often constrained by anatomical limitations. In this situation, efforts should be made to find the exact meaning of T1s-CL and whether there are any alternatives to it.
Methods We enrolled 117 patients who received two-level anterior cervical discectomy and fusion (ACDF). Occipital slope, C2 slope (C2s), C7 slope (C7s), T1, O-C2 angle (O-C2A), C2-7 angle (C2-7A), O-C7 angle (O-C7A), T1s-CL, C7-T1 angle (C7-T1A), and C2-7 sagittal vertical axis were measured. We determined 16° (T1s-CL) as the reference point for dividing subjects into the mismatch group and the balance group, and a comparative analysis was performed.
Results The mean value of C7-T1A was constantly maintained within 2.6° peri-operatively. In addition, C2s and T1s-CL showed the same absolute change (Δ|0.8|°). The mean values of T1s-CL of the mismatch and balance groups were 23.0° and 7.6°, respectively. The five factors with the largest differences between the two groups were as follows : C2s (Δ13.3°), T1s-CL (Δ15.4°), O-C2A (Δ8.7°), C2-7A (Δ14.7°), and segmental angle (Δ7.9°) before surgery. Only four factors showed statistically significant change between the two groups after ACDF : T1s-CL (Δ4.0° vs. Δ0.2°), C2s (Δ3.2° vs. Δ0.7°), O-C2A (Δ2.6° vs. Δ1.3°), C2-7A (Δ6.3° vs. Δ1.3°). A very strong correlation between T1s-CL and C2s was also found (r=|0.88–0.96|).
Conclusion C2s itself may be the essential key to represent T1s-CL. The amounts and directions of change of these two factors (T1s-CL and C2s) were also almost identical. The above phenomenon was re-confirmed once again through the correlation analysis.
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Affiliation(s)
- Ho Jin Lee
- Department of Neurosurgery, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Soon Tae You
- Department of Neurosurgery, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Jae Hoon Sung
- Department of Neurosurgery, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Il Sup Kim
- Department of Neurosurgery, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Jae Taek Hong
- Department of Neurosurgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Lee HJ, Kim IS, Hong JT. Physiologic Cervical Alignment Change between Cervical Spine X-ray and Computed Tomography. J Korean Neurosurg Soc 2021; 64:784-790. [PMID: 34315198 PMCID: PMC8435648 DOI: 10.3340/jkns.2020.0320] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/13/2021] [Indexed: 11/27/2022] Open
Abstract
Objective The purpose of this study was to investigate the correlations among various radiological parameters used to determine cervical alignment from cervical spine radiographs (X-CS) and cervical spine computed tomography (CT-CS), both within and between modalities.
Methods This study included 168 patients (≤60 years old) without a definite whole spine deformity who underwent CT-CS and X-CS. We measured occipital slope (O-s), C1 slope, C2 slope, C7 slope, sella turcica - C7 sagittal vertical axis (StC7-SVA), spinocranial angle, T1 slope, and C27-SVA. We calculated the O-C2 angle, O-C7 angle, and C2-7 angle from the measured parameters and conducted correlation analyses among multiple parameters.
Results The intrinsic correlation features among multiple cervical parameters were very similar for both X-CS and CT-CS. The two SVA parameters (C27-SVA and StC7-SVA) were mainly influenced by the upper cervical slope parameters (r=|0.13–0.74|) rather than the lower slope cervical parameters (r=|0.08–0.13|). The correlation between X-CS and CT-CS for each radiological parameter was statistically significant (r=0.26–0.44) except for O-s (r=0.10) and StC7-SVA (r=0.11).
Conclusion The correlation patterns within X-CS and CT-CS were very similar in this study. The correlation between X-ray and CT was statistically significant for most radiological parameters, and the correlation score increased when the horizontal gaze was consistently maintained. The lower cervical parameters were not statistically associated with translation-related parameters (C2-7 SVA and StC7-SVA). Therefore, the upper cervical segment may be a better predictor for determining head and neck translation.
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Affiliation(s)
- Ho Jin Lee
- Department of Neurosurgery, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Il Sup Kim
- Department of Neurosurgery, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Jae Taek Hong
- Department of Neurosurgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Influence of dynamic neck motion on the clinical usefulness of multi-positional MRI in cervical degenerative spondylosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:1542-1550. [PMID: 33591439 DOI: 10.1007/s00586-021-06760-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 12/08/2020] [Accepted: 02/02/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this study was to find out additional indications for multi-positional MRI in cervical degenerative spondylosis (CDS) patients. MATERIAL AND METHODS A total of 63 patients with cervical spondylotic myelopathy that underwent multi-positional MRI and X-ray were included. Muhle's grade, C2-7 angle, and C7 slope were measured. Patients were assigned to the stenosis group (Group S) when Muhle's grades were increased by more than two or maximum grade was reached. Other patients were assigned to the maintenance group (Group M). Receiver operating characteristic (ROC) analysis was performed. Statistical significance was accepted for p values of < 0.05. RESULTS A total of 24 patients were assigned to the S group and 39 patients to the M group. Mean C2-7 angle difference in extension (eC27A) between S and M groups was 10.97° (p = 0.002). The mean inter-group difference between C2-7 angle in extension and neutral positions (e-nC27A) was 14.39° (p = 0.000). Mean C7 slope difference in neutral position was - 6.53° (p = 0.002). Based on areas under ROC curves (AUCs), e-nC27A, eC27A, and negative C7 slope had AUCs of 0.934 (95% CI 0.876-0.992), 0.752 (95% CI 0.624-0.880), and 0.720 (95% CI 0.588-0.851), respectively. The optimal cutoff value of e-nC27A was 15.4 degrees, which had a diagnostic accuracy of 88.9%. CONCLUSION Multi-positional MRI helps to find dynamic cord compressive lesion in CDS patients. The higher eC27A, e-nC27A values and smaller C7 slope were found to increase the likelihood of cervical dynamic stenosis. Among other factors, we recommend multi-positional MRI before surgery especially when a patient's e-nC27A is > 15.4 degrees. LEVEL OF EVIDENCE I Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.
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Hong JT, Koller H, Abumi K, Yuan W, Falavigna A, Lee HJ, Lee JB, Le Huec JC, Park JH, Kim IS. A new nomenclature system for the surgical treatment of cervical spine deformity, developing, and validation of SOF system. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:1670-1680. [PMID: 33547943 DOI: 10.1007/s00586-021-06751-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 12/08/2020] [Accepted: 01/23/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To develop and assess the reliability of new nomenclature system that systematically organizes osteotomy techniques and briefly describes the surgical approach, the surgical sequence, and the fixation technique for cervical spine deformity (CSD). METHODS We developed a new classification system (SOF system) for CSD surgery that describes the sequence of surgical approach (S), the grade of osteotomy (O), and the information of fixation (F) using alphanumeric codes. Twenty CSD osteotomies (8 anterior osteotomies, 12 posterior osteotomies) were included in this study to evaluate the inter- and intra-observer agreement based on operation records. Six observers performed independent evaluations of the operation records in random order. Each observer described 20 CSD surgeries using the SOF system twice (> 30 days between assessments) based on operation records to validate SOF system. RESULTS Overall agreement (among all six observers at the initial assessment) on the anterior and posterior osteotomy was ICC = 0.96 and ICC = 0.91, respectively. Overall agreement (repeat observations after at least 30 days) on the anterior and posterior osteotomy was ICC = 0.96 and ICC = 0.91, respectively. This data showed that both inter- and intra-observer agreement revealed 'excellent'. CONCLUSION This study introduces the SOF system of the CSD surgery to understand the surgical sequence, the type of osteotomy and the fixation techniques. The investigation of the inter- and intra-observer agreement revealed 'excellent agreement' for both anterior and posterior osteotomies. Thus, SOF system can provide a consistent description of the various CSD surgeries and its use will provide a common frame for CSD surgery and help communicate between surgeons.
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Affiliation(s)
- Jae Taek Hong
- Department of Neurosurgery, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
| | - Heiko Koller
- Department of Neurosurgery, Technical University of Munich, Munich, Germany
| | - Kuniyoshi Abumi
- Department of Orthopedic Surgery, Sapporo Orthopedic Hospital, Sapporo, Japan
| | - Wen Yuan
- Department of Orthopedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Asdrubal Falavigna
- Department of Neurosurgery, University of Caxias Do Sul, Caxias Do Sul, RS, Brazil
| | - Ho Jin Lee
- Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Jong Beom Lee
- Department of Neurosurgery, Chungbuk National University Hospital, Cheongju, Korea
| | - Jean-Charles Le Huec
- Department of Orthopedic Surgery, Bordeaux University Hospital, Bordeaux, France
| | - Jong-Hyeok Park
- Department of Neurosurgery, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Korea
| | - Il Sup Kim
- Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
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Lee SH, Hyun SJ, Jain A. Cervical Sagittal Alignment: Literature Review and Future Directions. Neurospine 2020; 17:478-496. [PMID: 33022153 PMCID: PMC7538362 DOI: 10.14245/ns.2040392.196] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/13/2020] [Indexed: 12/26/2022] Open
Abstract
Cervical alignment as a concept has come to the forefront for spine deformity research in the last decade. Studies on cervical sagittal alignment started from normative data, and expanded into correlation with global sagittal balance, prognosis of various conditions, outcomes of surgery, definition and classification of cervical deformity, and prediction of targets for ideal cervical reconstruction. Despite the recent robust research efforts, the definition of normal cervical sagittal alignment and cervical spine deformity continues to elude us. Further, many studies continue to view cervical alignment as a continuation of thoracolumbar deformity and do not take into account biomechanical features unique to the cervical spine that may influence cervical alignment, such as the importance of musculature connecting cranium-cervical-thoracic spine and upper extremities. In this article, we aim to summarize the relevant literature on cervical sagittal alignment, discuss key results, and list potential future direction for research using the '5W1H' framework; "WHO" are related?, "WHY" important?, "WHAT" to evaluate and "WHAT" is normal?, "HOW" to evaluate?, "WHEN" to apply sagittal balance?, and "WHERE" to go in the future?
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Affiliation(s)
- Sang Hun Lee
- Department of Orthopaedic Surgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Seung-Jae Hyun
- Department of Neurological Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Amit Jain
- Department of Orthopaedic Surgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
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Comparison of whole body sagittal alignment during directed vs natural, relaxed standing postures in young, healthy adults. Spine J 2019; 19:1832-1839. [PMID: 31233893 DOI: 10.1016/j.spinee.2019.06.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 06/14/2019] [Accepted: 06/14/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Imaging for adult spinal deformity is conventionally performed in a directed manner to assess the most upright standing posture one can assume. However, this method does not reflect an individual's natural, relaxed posture, which is the posture a patient likely reverts to postoperatively, and also the posture likely to explain spinal pathologies. PURPOSE To identify radiographic differences between directed and natural, relaxed standing postures in young healthy subjects. STUDY DESIGN A randomized, prospective, radiographic study. PATIENT SAMPLE Sixty healthy 21-year-old subjects (48 male, 12 female). OUTCOME MEASURES Radiographic parameters including sagittal vertical axis (SVA), C2 SVA, C2-7 SVA global cervical angle, T1-slope, global thoracic angle (GTA), thoracolumbar angle (TLA), global lumbar angle (GLA), sacral slope, pelvic tilt (PT), pelvic incidence, femoral alignment angle (FAA), and knee alignment angle (KAA). METHODS The EOS whole body radiographs of patients in directed and natural, relaxed standing postures were obtained, with subsequent comparison of radiographic parameters. Differences in Roussouly curve types, sagittal curve apices, and end vertebrae were also evaluated. Univariate analyses using Wilcoxon sign-rank, paired t tests, and paired chi-square tests were performed. RESULTS Compared with directed standing, natural, relaxed standing results in a more kyphotic spinal profile marked by a significantly less lordotic GLA, larger GTA, TLA, and T1-slope. The PT+FAA demonstrated true hip movement during sagittal balancing. Lower thoracic and lumbar apices, lower thoracolumbar end vertebrae, and lower Roussouly curve types were observed during natural, relaxed standing. CONCLUSIONS Our study found significant differences in sagittal radiographic parameters between directed standing and the natural, relaxed standing posture, with the latter demonstrating a more kyphotic spinal profile in terms of magnitude and span, as well as complementary changes in cervical and spinopelvic alignment. The natural, relaxed standing posture, a marker for energy conservation principles in standing, may infer value in less aggressive lordotic restoration, as well as concentration of lordosis in the lower lumbar spine.
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