An investigation of cervicovertebral morphology in different sagittal skeletal growth patterns

Morphological comparison of cervical vertebrae in adult females with different sagittal craniofacial patterns: A cross-sectional study

INTRODUCTION

Cervical vertebral maturation (CVM) methods have gained popularity to assess growth and development status for orthodontic patients. Although craniofacial and craniocervical structures are known to be associated, there is no evidence in the literature if this relation might negatively affect the accuracy of CVM assessments. Therefore, this study aimed to comparatively investigate the sizes of the 2(nd), 3(rd), and 4(th) cervical vertebrae in adult females (radius union stage of skeletal maturity) who have different sagittal skeletal patterns.

MATERIALS AND METHODS

A cross-sectional study was conducted, and 151 lateral cephalometric radiographs of adult female patients were assessed in the study. Patients were assigned to three groups according to ANB angle. Parameters including concavity depth at the lower border of the 2(nd), 3(rd), and 4(th) cervical vertebrae and base length, upper border length, body length, posterior height, anterior height, and body height of the 3(rd) and 4(th) cervical vertebrae bodies were measured. One-way analysis of variance was used for between-group comparisons.

RESULTS

No statistically significant differences were found between groups in terms of concavity depth at the lower borders of the 2(nd), 3(rd), and 4(th) cervical vertebrae (P > 0.05). Base length, upper border length, body length, posterior height, anterior height, and body height of the 3(rd) and 4(th) cervical vertebrae were also similar between groups (P > 0.05).

CONCLUSIONS

The results of this study supports that sagittal craniofacial pattern has no effect on the accuracy of using the methods assessing CVM and calculating cervical vertebral age.

Developmental steps of the human cervical spine: parameters for evaluation of skeletal maturation stages

The central objective of this investigation was to focus on the development of the cervical spine observed by lateral cephalometric radiological images of children and adolescents (6-16 years old). A sample of 26 individuals (12 girls and 14 boys) was classified according to stages of cervical spine maturation in two subcategories: group I (initiation phase) and group II (acceleration phase). The morphology of the cervical spine was assessed by lateral cephalometric radiographs obtained in accordance with an innovative method for establishing a standardized head posture. A total of 29 linear variables and 5 angular variables were used to clarify the dimensions of the cervical vertebrae. The results suggest that a few measurements can be used as parameters of vertebral maturation both for males and females. The aforementioned measurements include the inferior depth of C2-C4, the inferior depth of C5, the anterior height of C4-C5, and the posterior height of C5. We propose original morphological parameters that may prove remarkably useful in the determination of bone maturational stages of the cervical spine in children and adolescents.

Differences in male and female spino-pelvic alignment in asymptomatic young adults: a three-dimensional analysis using upright low-dose digital biplanar X-rays

STUDY DESIGN

A three-dimensional analysis of spino-pelvic alignment in 60 asymptomatic young adult males and females.

OBJECTIVES

To analyze the differences in sagittal spino-pelvic alignment in a group of asymptomatic young adult males and females and describe gender specific reference values.

SUMMARY OF BACKGROUND DATA

Several spinal disorders like idiopathic scoliosis and Scheuermann's disease have a well-known sex-related prevalence ratio. As spino-pelvic alignment plays an important role in spinal biomechanics, it is imperative to analyze possible differences between the male and female spino-pelvic alignment. Furthermore, in spinal fusion surgery, normal sagittal balance should be recreated as closely as possible.

METHODS

An innovative biplanar ultra low-dose radiographic technique was used to obtain three-dimensional reconstructions of the spine (T1-L5), sacrum, and pelvis in a freestanding position of 30 asymptomatic young male and 30 young female adults. Values were calculated for thoracic kyphosis (T4-T12), lumbar lordosis (L1-S1), total and regional lumbopelvic lordosis (PRT12, PRL2, PRL4, and PRL5), sagittal plumb line of T1, T4, and T9 (HAT1, HAT4, and HAT9), T1-L5 sagittal spinal inclination, T9 sagittal offset, and pelvic parameters (pelvic tilt, sacral slope, and pelvic incidence). In addition, vertebral inclination in the sagittal plane of each vertebra was measured. Differences in spino-pelvic alignment between the sexes were analyzed.

RESULTS

The female spine was more dorsally inclined (11 degrees vs. 8 degrees ; P = 0.003). High thoracic and thoracolumbar vertebrae were more dorsally inclined in women than in men. Thoracic kyphosis, lumbar lordosis, regional lumbopelvic lordosis, sagittal plumb lines, T9 sagittal offset, and pelvic parameters were not statistically different between the sexes.

CONCLUSION

These results indicate that the female spine is definitely different from the male spine. The spine as whole and individual vertebrae in certain regions of the normal spine is more backwardly inclined in females than in males. Based on our previous research this signifies that these spinal regions are subjected to different biomechanical loading conditions. These vertebral segments are possibly less rotationally stable in females than in males.

Cervical Headgear Effects on the Morphology of the Cervical Vertebrae and Cervical Posture

OBJECTIVE

To test the hypothesis that use of cervical headgear has an important effect on the morphology of the cervical vertebrae and cervical posture.

MATERIALS AND METHODS

The material consisted of pretreatment and posttreatment lateral cephalograms and initial hand-wrist films of 30 subjects who were receiving cervical headgear therapy. Preobservation and postobservation control cephalograms and preobservation hand-wrist films of 15 untreated subjects served as controls. The average treatment time for the treatment group was 9.06 +/- 1.02 months, and the average observation period for the control group was 10.0 +/- 1.1 months. A paired t-test was applied to compare the changes occurring during the examination and observation periods in both groups. In addition, Student's t-test was performed to assess the differences between the groups.

RESULTS

The results of the paired t-test showed that within each group there were statistically significant differences in the majority of measurements concerning the morphology of the cervical vertebrae, whereas the measurements concerning cervical posture showed no significant changes in either group. According to the results of the Student's t-test, however, no statistically significant changes between the treatment and control group were present except with regard to two measurements.

CONCLUSIONS

Changes in the cervicovertebral morphology in the treatment group were achieved more by growth than by cervical headgear treatment. Although high individual variations were found in postural variables, cervical posture did not change over a period of 9 months either in the treatment group or in the control group.