Clinical significance of cervical vertebral flexion and extension spatial alignment changes

The Incidence, Changes and Treatments of Cervical Deformity After Infection and Inflammation

A healthy cervical spine with normal movement is the basis of many daily activities and is essential for maintaining a good quality of life. However, the alignment, fusion, and structure of the cervical spine can change for various reasons, leading to cervical deformity, mainly kyphosis. Approximately 5%‒20% of spinal infections in the cervical spine cause cervical deformity. The deformity can recover early; however, the disease's long-term existence or the continuous action of abnormal stress may lead to intervertebral fusion and abnormal osteophytes. Many gaps and controversies exist regarding infectious cervical deformities, including a lack of clear definitions and an acceptable classification system thereby requiring further research. Moreover, there is no consensus on the indications for postinfectious cervical deformity associated with <i>Mycobacterium tuberculosis</i>, <i>Staphylococcus aureus</i>, and Brucellosis. Therefore, we reviewed and discussed the incidence, clinical manifestations, changes, and treatment of infectious and inflammatory secondary cervical deformities from common to rare to provide a theoretical basis for clinical decision-making.

Spinopelvic alignment and low back pain after total hip arthroplasty: a scoping review

Objective

Spinopelvic alignment is increasingly considered as an essential factor for maintaining an energy-efficient posture in individuals with normal or pathological status. Although several previous studies have shown that changes in the sagittal spinopelvic alignment may occur in patients undergoing total hip arthroplasty (THA), no review of this area has been completed so far. Thus, the objective of this scoping review was to summarize the evidence investigating changes in spinopelvic alignment and low back pain (LBP) following THA.

Data sources

We adhered to the established methodology for scoping reviews. Four electronic databases were systematically searched from inception-December 31, 2021.

Study selection

We selected prospective or retrospective observational or intervention studies that included patients with THA.

Data extraction

Data extraction and levels of evidence were independently performed using standardized checklists.

Data synthesis

A total of 45 papers were included in this scoping review, involving 5185 participants with THA. Pelvic tilt was the most common parameter measured in the eligible studies (n = 26). The results were not consistent across all studies; however, it was demonstrated that the distribution of pelvic tilt following THA had a range of 25° posterior to 20° anterior. Moreover, decreased sacral slope and lower pelvic incidence were associated with increased risk of dislocation in patients with THA. Lumbar spine scoliosis did not change significantly after THA in patients with bilateral hip osteoarthritis (5.50°(1.16°) vs. 3.73°(1.16°); P-value = 0.29). Finally, one study indicated that LBP improvement was not correlated with postoperative changes in spinopelvic alignment parameters. Several methodological issues were addressed in this study, including no sample size calculation and no type-I error adjustment for outcome multiplicity.

Conclusions

Changes in spinopelvic alignment may occur after THA and may improve with time. Patients with a THA dislocation usually show abnormal spinopelvic alignment compared to patients without a THA dislocation. LBP usually improves markedly over time following THA.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-022-05154-7.

A Radiographic Analysis of Cervical Sagittal Alignment in Adolescent Idiopathic Cervical Kyphosis

OBJECTIVE

The aim of this study was to analyze the radiologic features of adolescent idiopathic cervical kyphosis.

SUMMARY OF BACKGROUND DATA

There are few previous reports about radiographic analysis of cervical sagittal alignment of adolescent idiopathic cervical kyphosis. A new method was proposed in this article to evaluate the severity of cervical kyphosis.

PATIENTS AND METHODS

A total of 41 adolescent patients with cervical kyphosis were reviewed. Several angles were measured from the radiographs utilizing the 2-line Cobb method and Harrison posterior tangent method. Ishihara's Curvature Index (CI), Kyphosis Index (KI), kyphosis levels, and the apex of the kyphosis were also measured.

RESULTS

The results showed that the apex of the kyphosis is located at the posterior-superior edge of C4 (70.7%) and C5 (29.3%). C2-C7 angles ranged from 4.7 to 71.3 degrees (36.2±13.6 degrees) and from 9.8 to 83.1 degrees (36.4±15.1 degrees) in the above 2 methods, respectively. Local angles of kyphotic area ranged from 21.8 to 96.3 degrees (50.5±23.7 degrees) in 2-line Cobb method and from 19.8 to 105.6 degrees (52.0±19.5 degrees) in Harrison posterior tangent method. CI and KI ranged from 8.6 to 79.8 (36.8±16.7) and 15.2 to 141.9 (50.6±23.7), respectively. Statistical analysis showed that there was significant positive correlation between KI and kyphosis angle.

CONCLUSIONS

In adolescent idiopathic cervical kyphosis, the alteration of the sagittal profile only occurs on partial cervical alignment rather than the whole cervical spine. The apex of the kyphosis locates at posterior-superior edge of the vertebrae. It seems that KI can accurately depict the severity of cervical kyphosis.