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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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Fang JJ, Shen LM. Analysis of sagittal spinal alignment at the adolescent age: for furniture design. ERGONOMICS 2023; 66:1477-1493. [PMID: 36437772 DOI: 10.1080/00140139.2022.2152491] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/21/2022] [Indexed: 06/16/2023]
Abstract
Knowledge of the parameters of the human spine is essential in designing ergonomic furniture. The purpose of this study was to evaluate spinal alignment in adolescents of various ages. The lengths, curvatures, and concave-convex spacings of the spine were investigated in 268 participants aged 9-18 years. Ten ages were classified, and the rate of increase of parameters was calculated for each age and age group. The results showed that spinal parameters, except for cervical lordosis, increased with age. Adolescents were classified as 9-10, 11-12, 13-15, and 16-18 years old. A rapid increment of lengths and concave-convex spacings occurred at ages 13-15, while that of curvatures occurred at ages 16-18. Spinal parameters differed significantly among the age groups (p < 0.05). Concave-convex spacings reflected differences in the spine more clearly than the other parameters. This study suggests the necessity of designing spine-related furniture based on spinal parameters, thus providing adaptive support for the adolescent spine, particularly the lumbar spine. Practitioner summary: This study examined spinal lengths, curvatures, and concave-convex spacings in adolescents aged 9-8 years and then divided them into four age groups. Concave-convex spacings effectively reflected spinal differences between age groups, particularly the lumbar spine. These results can inform the ergonomic design of spine-related furniture.HIGHLIGHTSSpinal parameters increased progressively between 9 and 18 years. Regression analysis showed good linear correlations between TK, LL, SK, TS, and LS with age.Age classification of adolescents was Group I (9-10 years), Group II (11-12 years), Group III (13-15 years), and Group IV (16-18 years). The rapid increment of lengths and concave-convex spacings were in Group III while that of curvatures were in Group IV.Concave-convex spacings were vital parameters to evaluate the global balance of the spine.The lumbar spine is an essential segment for characterizing spinal alignment.
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Affiliation(s)
- Jiao-Jiao Fang
- College of Furnishings and Industrial Design, Nanjing Forestry University, Nanjing, China
- Jiangsu Co-Innovation Center of Efficient Processing and Utilization of Forest Resources, Nanjing Forestry University, Nanjing, China
| | - Li-Ming Shen
- College of Furnishings and Industrial Design, Nanjing Forestry University, Nanjing, China
- Jiangsu Co-Innovation Center of Efficient Processing and Utilization of Forest Resources, Nanjing Forestry University, Nanjing, China
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Jiang C, Jiang F, Xie Z, Sun J, Sun Y, Zhang M, Zhou J, Feng Q, Zhang G, Xing K, Mei H, Li J. Evaluation of automated detection of head position on lateral cephalometric radiographs based on deep learning techniques. Ann Anat 2023; 250:152114. [PMID: 37302431 DOI: 10.1016/j.aanat.2023.152114] [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: 03/14/2023] [Revised: 05/13/2023] [Accepted: 05/20/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Lateral cephalometric radiograph (LCR) is crucial to diagnosis and treatment planning of maxillofacial diseases, but inappropriate head position, which reduces the accuracy of cephalometric measurements, can be challenging to detect for clinicians. This non-interventional retrospective study aims to develop two deep learning (DL) systems to efficiently, accurately, and instantly detect the head position on LCRs. METHODS LCRs from 13 centers were reviewed and a total of 3000 radiographs were collected and divided into 2400 cases (80.0 %) in the training set and 600 cases (20.0 %) in the validation set. Another 300 cases were selected independently as the test set. All the images were evaluated and landmarked by two board-certified orthodontists as references. The head position of the LCR was classified by the angle between the Frankfort Horizontal (FH) plane and the true horizontal (HOR) plane, and a value within - 3°- 3° was considered normal. The YOLOv3 model based on the traditional fixed-point method and the modified ResNet50 model featuring a non-linear mapping residual network were constructed and evaluated. Heatmap was generated to visualize the performances. RESULTS The modified ResNet50 model showed a superior classification accuracy of 96.0 %, higher than 93.5 % of the YOLOv3 model. The sensitivity&recall and specificity of the modified ResNet50 model were 0.959, 0.969, and those of the YOLOv3 model were 0.846, 0.916. The area under the curve (AUC) values of the modified ResNet50 and the YOLOv3 model were 0.985 ± 0.04 and 0.942 ± 0.042, respectively. Saliency maps demonstrated that the modified ResNet50 model considered the alignment of cervical vertebras, not just the periorbital and perinasal areas, as the YOLOv3 model did. CONCLUSIONS The modified ResNet50 model outperformed the YOLOv3 model in classifying head position on LCRs and showed promising potential in facilitating making accurate diagnoses and optimal treatment plans.
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Affiliation(s)
- Chen Jiang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Fulin Jiang
- Chongqing University Three Gorges Hospital, Chongqing 404031, China
| | - Zhuokai Xie
- University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Jikui Sun
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Yan Sun
- University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Mei Zhang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Jiawei Zhou
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Qingchen Feng
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Guanning Zhang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Ke Xing
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Hongxiang Mei
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Juan Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.
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Aino M, Oka S, Haruguchi K, Aino M, Hashimura S, Kurosawa K. Comparison of spinal column alignment and autonomic nervous activity using the intersegmental tenderness test in the segment above. J Phys Ther Sci 2021; 33:570-575. [PMID: 34393365 PMCID: PMC8332640 DOI: 10.1589/jpts.33.570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/10/2021] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The thoracolumbar supraspinous intersegmental tenderness test (ITT) in the
segment above was performed to compare spinal alignment and autonomic activity in the
presence or absence of pain. [Participants and Methods] Thirty young males were grouped
into Th1–4 (Cardiopulmonary visceral nerves), Th5–9 (Large visceral nerve), and Th10–12
(Small visceral nerve) by ITT for the presence of pain. Measurements of the spinal
alignment and autonomic function were performed. [Results] Those with ITT pain had a
significantly lower range of motion in the sagittal plane at Th12, Th12–L1, and L2–3 and
in the frontal plane at Th1–2, Th4–5, Th6–7, and L3–4 than those in the no pain group. On
autonomic function tests, the pain group had significantly lower Total Power, LF (Low
Frequency), and CVRR (Coefficient of variation of R-R interval). [Conclusion] In ITT,
patients with pain at Th5–9 have a mixture of reduced sagittal tilt angle and autonomic
hypofunction of the adjacent upper and lower thoracic to lumbar vertebrae.
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Affiliation(s)
- Masaki Aino
- Japan Systemic Fascia Neuro-Pain Approach Association: 1-13-24 Kashii Ekimae, Higashi-ku, Fukuoka-shi, Fukuoka 813-0013, Japan
| | - Shinichiro Oka
- Department of Physical Therapy, School of Health Sciences at Fukuoka, International University of Health and Welfare, Japan
| | | | - Mayumi Aino
- Department of Rehabilitation, Kitakyushu Koga Hospital, Japan
| | - Shun Hashimura
- Department of Rehabilitation, Kitakyushu Koga Hospital, Japan
| | - Kazuo Kurosawa
- Department of Physical Therapy, School of Health Sciences at Odawara, International University of Health and Welfare, Japan
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Boudreau C, Carrondo Cottin S, Ruel-Laliberté J, Mercier D, Gélinas-Phaneuf N, Paquet J. Correlation of supine MRI and standing radiographs for cervical sagittal balance in myelopathy patients: a cross-sectional study. 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; 30:1521-1528. [PMID: 33881642 DOI: 10.1007/s00586-021-06833-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/09/2021] [Accepted: 03/31/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Cervical sagittal alignment is correlated with myelopathy severity and used by spinal surgeons for surgical planification. Magnetic resonance imaging (MRI) is the gold standard for the evaluation of cervical myelopathy but may not be for the assessment of cervical sagittal balance compared to X-rays. The objective of this study was to assess the correlation of cervical alignment between supine MRI and standing radiographs in patients with cervical spondylotic myelopathy (CSM). METHODS Cobb, Jackson and Harrison methods were used to measure cervical sagittal alignment on supine MRI and standing radiographs of CSM adults. Cervical alignment was divided based on Cobb angle values on lordotic (> 4°), kyphotic (< - 4°) and rectitude (- 4° to 4°). Correlations between radiographic and MRI measurements were determined. Intra- and interobserver reliability were assessed and MRI and X-Ray-measured angles were compared. RESULTS One hundred and thirty patients with CSM were reviewed. Correlations of cervical lordosis measures between radiographs and MRI were strong using the Cobb (0.65) and Jackson (0.63) methods, and moderate using the Harrison (0.37) method. Mean cervical lordosis angle was significantly lower on supine MRI compared to standing radiographs for all methods (Cobb 11.6 Rx vs. 9.2 MRI, Jackson 14.6 vs. 11.6, Harrison 23.5 vs. 19.9). Eighteen patients (15.4%) without lordosis on supine MRI presented lordosis on standing radiographs. CONCLUSION A substantial proportion of patients has sagittal alignment discrepancies between supine MRI and standing radiographs. Therefore, standing radiographs of the cervical spine should always be included in surgical planning of CSM patients.
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Affiliation(s)
- Catherine Boudreau
- Department of Neurosciences, CHU de Québec - Université Laval Research center, Quebec, QC, Canada
| | - Sylvine Carrondo Cottin
- Department of Neurosciences, CHU de Québec - Université Laval Research center, Quebec, QC, Canada
| | - Jessica Ruel-Laliberté
- Department of Neurosciences, CHU de Québec - Université Laval Research center, Quebec, QC, Canada
| | - David Mercier
- Hôpital de L'Enfant-Jésus, Neurosurgery, CHU de Québec - Université Laval, 1401 18e rue, Quebec, QC, G1J1Z4, Canada
| | - Nicholas Gélinas-Phaneuf
- Hôpital de L'Enfant-Jésus, Neurosurgery, CHU de Québec - Université Laval, 1401 18e rue, Quebec, QC, G1J1Z4, Canada
| | - Jérôme Paquet
- Department of Neurosciences, CHU de Québec - Université Laval Research center, Quebec, QC, Canada. .,Hôpital de L'Enfant-Jésus, Neurosurgery, CHU de Québec - Université Laval, 1401 18e rue, Quebec, QC, G1J1Z4, Canada.
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Sagittal balance of the cervical spine: a systematic review and meta-analysis. 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; 30:1411-1439. [PMID: 33772659 DOI: 10.1007/s00586-021-06825-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 09/26/2020] [Accepted: 03/20/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of this systematic review and meta-analysis was to compare the cervical sagittal parameters between patients with cervical spine disorder and asymptomatic controls. METHODS Two independent authors systematically searched online databases including Pubmed, Scopus, Cochrane library, and Web of Science up to June 2020. Cervical sagittal balance parameters, such as T1 slope, cervical SVA (cSVA), and spine cranial angle (SCA), were compared between the cervical spine in healthy, symptomatic, and pre-operative participants. Where possible, we pooled data using random-effects meta-analysis, by CMA software. Heterogeneity and publication bias were assessed using the I-squared statistic and funnel plots, respectively. RESULTS A total of 102 studies, comprising 13,802 cases (52.7% female), were included in this meta-analysis. We used the Newcastle-Ottawa Scale (NOS) to evaluate the quality of studies included in this review. Funnel plot and Begg's test did not indicate obvious publication bias. The pooled analysis reveals that the mean (SD) values were: T1 slope (degree), 24.5 (0.98), 25.7 (0.99), 25.4 (0.34); cSVA (mm), 18.7 (1.76), 22.7 (0.66), 22.4 (0.68) for healthy population, symptomatic, and pre-operative assessment, respectively. The mean value of the SCA (degree) was 79.5 (3.55) and 75.6 (10.3) for healthy and symptomatic groups, respectively. Statistical differences were observed between the groups (all P values < 0.001). CONCLUSION The findings showed that the T1 slope and the cSVA were significantly lower among patients with cervical spine disorder compared to controls and higher for the SCA. Further well-conducted studies are needed to complement our findings.
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Cervical Extensor Muscles Play the Role on Malalignment of Cervical Spine: A Case Control Study With Surface Electromyography Assessment. Spine (Phila Pa 1976) 2021; 46:E73-E79. [PMID: 33038198 DOI: 10.1097/brs.0000000000003742] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A case control study. OBJECTIVE The aim of this study was to identify the potential impact of cervical spine malalignment on muscle parameters. SUMMARY OF BACKGROUND DATA Muscular factors are associated with cervical alignment. Nevertheless, only muscle dimensions or imaging changes have been evaluated, function of cervical muscles has scarcely been investigated. METHODS Thirty-four patients diagnosed as cervical spine degeneration associated with cervical malalignment and 32 control subjects were included in this case control study. Visual analogue scale (VAS) and the neck disability index (NDI) were used. The sagittal alignment parameters and cervical range of motion (ROM) were measured on cervical spine lateral radiographs, included C2-C7 lordosis, C2-C7 sagittal vertical axis (C2-C7 SVA), cervical gravity-sagittal vertical axis (CG-SVA), T1-Slope, and spinal canal angle (SCA). Surface electromyography (SEMG)-based flexion-relaxation ratio (FRR) was measured. RESULTS The result showed VAS score of the neck significantly lower in controls (P<0.05), C2-C7 lordosis, C2-C7 SVA, CG-SVA, T1-Slope and ROM showed significantly different (P<0.001) between malalignment group and control group, FRR of splenius capitis (FRRSpl) and upper trapezius (FRRUTr) of the malalignment group were lower than in the control group, which correlated well with NDI (rSpl = -0.181 rUTr = -0.275), FRRSpl correlated well with VAS (rSpl = -0.177). FRRSpl correlated strongly with C2-C7 SVA (r = 0.30), CG-SVA (r = 0.32), T1-Slope (r = 0.17), ROM (r = 0.19), FRRUTr correlated with C2-C7 lordosis (r = -0.23), CG-SVA (r = 0.19), T1-Slope (r = 0.28), ROM (r = 0.23). CONCLUSION Cervical malalignment patients had more tensional posterior cervical muscle and poor muscle functions. CG-SVA showed advantages in evaluating cervical malalignment.Level of Evidence: 3.
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