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Source publication
Purpose
Little information is available on the relationship between cervical sagittal alignment and health-related quality of life (HRQOL) in adolescent idiopathic scoliosis (AIS) patients. The aim of this study was to identify relationships between postoperative cervical sagittal alignment and HRQOL in AIS.
Methods
The study and control groups com...
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Background
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Background: This study aims to evaluate the effects of bracing on the Cobb’s angle (CA) and spinopelvic parameters in adolescent idiopathic scoliosis (AIS) patients.
Methods: A total of 51 AIS patients who received bracing treatment between January 2018 and August 2019 were retrospectively analyzed. The pro-bracing and in-bracing radiographs were a...
This research was performed to identify the incidence of spinal and lower extremity deformity and to identify the relationship of the incidence between the physical characteristics. One hundred forty-seven Physical Education major students and 54 nonmajor students participated in this study. Data collecting was performed by questionnaire and visual...
Citations
... Cervical sagittal alignment has been reported to affect the health-related quality of life (HRQOL) in various diseases [9][10][11], including AIS [12]. Moreover, we investigated shortterm outcomes regarding neck and shoulder pain (NSP) and reported that 40% of patients had NSP with 3 or greater cm on the visual analog scale (VAS) at the 2-year follow-up [13]. ...
... In other words, maintaining or restoring TK during PSF for thoracic AIS might prevent a postoperative decrease in CL or cervical kyphosis, resulting in a reduced NSP at 10-year after PSF. The relationships among 10-year postoperative parameters were in line with the relationships among short-term (minimum 2 years) postoperative parameters reported previously [3,4,12,25]. Therefore, surgeons should consider these findings when planning surgical procedures for thoracic AIS. ...
We aimed to determine the clinical significance of neck and shoulder pain (NSP) 10 years after posterior spinal fusion (PSF) for thoracic adolescent idiopathic scoliosis (AIS) and the relationship between radiographic parameters and NSP.
Of 72 patients who underwent PSF for thoracic AIS (Lenke 1 or 2) between 2000 and 2013, we included 52 (46 females; Lenke type 1 in 34 patients and type 2 in 18; mean age, 25.6 years) who underwent NSP evaluation using visual analog scale (VAS, 10 cm) 10 years postoperatively (follow-up rate, 72.2%). Correlation analyses were performed using Spearman’s rank correlation coefficient (r).
The VAS for NSP was 2.6 cm in median and 3.4 cm in mean at 10 years. The VAS had significant negative correlations with several SRS-22 domain scores (rs = − 0.348 for pain, − 0.347 for function, − 0.308 for mental health, and − 0.372 for total) (p < 0.05). In addition, the VAS score was significantly correlated with cervical lordosis (CL) (rs = 0.296), lumbar lordosis (rs = − 0.299), and sacral slope (rs = 0.362) (p < 0.05). Furthermore, at the 10-year follow-up, CL was significantly negatively correlated with T1 slope (rs = − 0.763) and thoracic kyphosis (TK) (− 0.554 for T1-12 and − 0.344 for T5-12) (p < 0.02).
NSP was associated with deterioration in SRS-22 scores, indicating that NSP is a clinically significant long-term issue in PSF for thoracic AIS. Restoring or maintaining the TK and T1 slopes, which are controllable factors during PSF, may improve cervical lordosis and alleviate NSP at 10-year follow-up.
... Cervical kyphosis is also likely to play a substantial role in the development of cervical myelopathy [39,40]. However, the relationship between CSA and clinical outcomes, including QOL, in AIS is limited and controversial [41]. In AIS patients, frequent long-term neck pain after surgical treatment is correlated with CSA [42,43] and a significant relationship is found between postoperative cervical sagittal parameters and health-related QOL scores [41,[43][44][45]. ...
... However, the relationship between CSA and clinical outcomes, including QOL, in AIS is limited and controversial [41]. In AIS patients, frequent long-term neck pain after surgical treatment is correlated with CSA [42,43] and a significant relationship is found between postoperative cervical sagittal parameters and health-related QOL scores [41,[43][44][45]. On the other hand, Cho et al. reported that CSA improved after corrective surgery for AIS, but there was no significant association between clinical outcomes and CSA [14]. ...
Reciprocal sagittal alignment changes after adolescent idiopathic scoliosis (AIS) posterior corrective surgery have been reported in the cervical spine, but the evidence is not yet sufficient. Furthermore, much remains unknown about the effects of cervical kyphosis on clinical outcomes in AIS. Forty-five consecutive patients (4 males and 41 females) with AIS and Lenke type 1 or 2 curves underwent a posterior spinal fusion, and a minimum of 24-month follow-up was collected from our prospective database. We investigated radiographic parameters and SRS-22r. Before surgery, cervical kyphosis (cervical lordosis < 0°) was present in 89% and cervical hyperkyphosis (cervical lordosis < −10°) in 60%. There were no significant differences in age, sex, or Lenke type between the hyperkyphosis and the non-hyperkyphosis groups. Although cervical lordosis increased significantly after surgery, cervical kyphosis was observed in 73% of patients 2 years after surgery. We found a significant correlation between Δthoracic kyphosis (TK) and Δcervical lordosis. Preoperative cervical kyphosis, ΔT1 slope, and ΔTK were independently associated factors for postoperative cervical hyperkyphosis. The cervical hyperkyphosis group had significantly lower SRS-22r domains. In AIS corrective surgery, restoring TK leading to a gain of T1 slope may lead to an improvement of cervical sagittal alignment. Remaining cervical hyperkyphosis after AIS surgery may affect clinical outcomes.
... [19] And C2-C7 SVA was also proved to be correlated with the SRS-22 scale of AIS patients in the study of Youn. [20] Therefore, C2-C7 SVA can be an essential parameter for scoliosis patients' evaluation. ...
Purpose: We aimed to analyze the cervical sagittal alignment change following the growing rod treatment in early-onset scoliosis (EOS) and identify the risk factors of sagittal cervical imbalance after growing-rod surgery of machine learning.
Materials and Methods: EOS patients from our center between 2007 and 2019 were retrospectively reviewed. Radiographic parameters include the cervical lordosis (CL), T1 slope, C2-C7 sagittal vertical axis (C2-7 SVA), primary curve Cobb angle, thoracic kyphosis (TK), C7-S1 sagittal vertical axis (C7-S1 SVA) and proximal junctional angle (PJA) were evaluated preoperatively, postoperatively and at the final follow-up. The parameters were analyzed using a t-test and χ2 test. The machine learning methodology of a sparse additive machine (SAM) was applied to identify the risk factors that caused the cervical imbalance.
Results:138 patients were enrolled in this study (96 male and 42 female). The mean thoracic curve Cobb angle was 67.00±22.74°. The mean age at the first operation was 8.5 ±2.6yrs. The mean follow-up was 38.48±10.87 months. CL, T1 slope, and C2-7 SVA increased significantly in the final follow-up compared with the pre-operative data. (P<0.05). The CL and T1 slope increased more significantly in the group of patients who had proximal junctional kyphosis (PJK) compared with the patients without PJK (P<0.05). The location of the upper instrumented vertebrae (UIV) and single/dual growing rod had no significant influence on the sagittal cervical parameters (P>0.05). According to the SAM analysis of machine learning algorithms, Postoperative PJK, more improvement of kyphosis, and T1 slope angle were identified as the risk factors of cervical sagittal imbalance during the treatment of growing rod surgery.
Conclusions: The growing rod surgery in EOS significantly affected the cervical sagittal alignment. Postoperative PJK and more improvement of kyphosis and T1 slope angle would lead to a higher incidence of cervical sagittal imbalance.
... Specifically, posterior spinal canal enlargement and laminoplasty achieved good prognostic effects during treatment (2,3). Currently, cervical sagittal parameters are receiving increasing attention and are widely used to predict quality of life (4)(5)(6)(7). Among them, the spinocranial angle (SCA), T1 slope (T1s) and C2-7 sagittal vertical axis (cSVA) are considered to be the three parameters that can better reflect sagittal balance and are also key research objects in the future (8). ...
... Recently, the significance of cervical alignment balance based on sagittal parameters has been gradually realized (4,5). Cervical sagittal parameters exhibit a close correlation with quality of life (6,7). Poor cervical equilibrium after the posterior approach is widely recognized as an important influencing factor leading to a decline in quality of life (6,13). ...
Background
The aims of this study were to identify the relationship between the spinocranial angle (SCA) and clinical outcomes and to explore whether the SCA is a suitable indicator to predict clinical outcomes for patients with ossification of the posterior longitudinal ligament (OPLL).
Methods
Sixty-five patients with cervical OPLL who underwent laminoplasty with at least 24 months of follow-up were selected for the current study and were divided into two groups according to whether the SCA was greater than or less than the mean preoperative SCA. Sagittal alignment changes were compared between the groups. The Pearson correlation coefficient was applied to assess the relationship among sagittal parameters. Univariate and multiple linear regression analyses were applied to identify the relationship between the recovery rate (RR) and radiological parameters.
Results
Patients were classified into two groups based on the mean value of preoperative SCA (85.1°). SCA was negatively correlated with T1 slope (T1s) and cervical lordosis (CL) and positively correlated with the C2–7 sagittal vertical axis (cSVA) ( p < 0.001). Patients with lower SCA had larger T1s and CL preoperatively and at the follow-up (T1s: p < 0.001; CL: p < 0.001) and showed greater loss of cervical lordosis after laminoplasty ( p < 0.001). However, no significant differences in the incidence of kyphosis, Japanese Orthopaedic Association (JOA) or RR were noted between the two groups. Although Pre-SCA, Pre-CL, F/U-CL and Pre-T1sCL were significantly associated with RR, these indicators were not associated with RR in the multivariate regression analysis.
Conclusion
Patients with lower SCA tended to have higher T1s and CL before surgery and greater loss of cervical lordosis at the follow-up visit but still maintained a greater lordosis angle. Although preoperative SCA is significantly related to RR, the relationship is not sufficient to indicate that preoperative SCA can be used to predict clinical outcomes. Therefore, further research is needed to confirm the impact of SCA on clinical outcomes for OPLL.
... Over the past few decades, an increasing number of studies have focused on cervical sagittal alignment [1][2][3][4][5][6][7][8]. It has been recognized that the normal function of the cervical spine largely relies on the cervical sagittal alignment, while abnormal morphology can cause pain, degeneration, disability and poor operative outcomes [2,5,[9][10][11][12][13]. ...
Purpose:
To describe the cervical spine morphology and explore its relationship to global sagittal alignment parameters in the asymptomatic adolescent population. METHODS: A total of 111 adolescent subjects were included. Sagittal alignment parameters, including C7 Slope, C2-C7 Cobb, C2-7 plumb line (PL), C2-S1 Sagittal Vertical Axis (SVA), C7-S1 SVA, T5-12 Cobb, T10-L2 Cobb, L1-S1 Cobb, pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS), were obtained from lateral radiographs. RESULTS: Forty-four males and sixty-seven females with a mean age of 16.12 ± 2.40 years were included in this study. The mean values of C7 Slope, C2-7 Cobb and C2-7PL were 20.45 ± 8.88°, -7.72 ± 12.10°, and 13.53 ± 11.63 mm, respectively. C2-7 Cobb, C7 Slope showed significant differences between the male and female groups. Correlation analysis showed that C7 slope was significantly correlated with C2-7 Cobb (r = -0.544, P < 0.001), C2-S1 SVA (r = 0.335, P < 0.001), and C7-S1 SVA (r = 0.310, P = 0.001), but not lumbosacral parameters(L5-S1 Cobb, PI, PT, SS). Using a modified method of Toyama to describe the cervical spine morphology, there were 37 cases (33.3%) in the Lordotic group, and C7 slope, C2-7 Cobb and C2-7PL showed significant differences between groups. According to C2-C7 Cobb, there were 80 Lordotic cases (72.1%). C7 slope and C2-7PL were significantly different between the two groups.
Conclusion:
The cervical spine morphology of asymptomatic adolescents varies widely, from lordotic to kyphotic. Combining different classification methods provides a better understanding of the morphology of the cervical spine. C7 slope is an important predictor of global sagittal balance and C2-7PL is a key parameter for restoring cervical lordosis, which should be considered pre-operatively and for conservative treatment. Cervical regional sagittal alignment parameters are not correlated with lumbosacral parameters, and C2-7 Cobb, C7 Slope showed significant differences between males and females.
... However, recently, spinal sagittal alignment, such as the cervical, thoracic, and lumbosacral spine, has been considered a more important subject in AIS [4,5]. Several reports showed that sagittal malalignment could increase the risk of developing neck or back pain and neurological symptoms in later life, suggesting that spinal sagittal alignment may be correlated with clinical and functional outcomes in AIS patients [6,7]. ...
Background
Few studies have examined the changes in cervical sagittal alignment (CSA) and its relationship with other sagittal alignments in AIS patients with major thoracolumbar/lumbar (TL/L) curve who underwent correction surgery. This study investigated the radiographical changes in CSA after correction surgery in patients with Lenke type 6 adolescent idiopathic scoliosis (AIS) and assess any possible factors affecting postoperative CSA.
Methods
Forty-four patients with Lenke type 6 AIS (3 males and 41 females, mean age at surgery of 15.6 ± 2.8 years) who could be followed up for 3 years after correction surgery were included in this study. Variations of outcome variables were analyzed in various spinal sagittal parameters using radiographic outcomes. Univariate correlation analyses were used to evaluate possible factors influencing the postoperative CSA. The Scoliosis Research Society (SRS)-22 questionnaires and the Oswestry Disability Index (ODI) were used for clinical evaluation, and the changes between pre- and 3-year post-operation were compared.
Results
The Cobb angle of the major and minor curve was significantly improved after correction surgery. Furthermore, CSA, such as C2-7 angle and T1 slope, changed significantly postoperatively. The magnitude of coronal curve correction did not affect CSA postoperatively, while the postoperative TK, T10-L2 kyphosis and LL were significantly correlated with the postoperative C2-7 angle, respectively. None of the patients in this study complained of neck or low back pain during the period up 3 years after the operation. Comparing each domain of SRS-22 or ODI score, these were unchanged between pre-, 1-year, and 3-year post-operation, with no statistically significant differences.
Conclusions
CSA changed significantly after correction surgery, and cervical kyphosis indicated a tendency to decrease in Lenke type 6 AIS patients, which was associated with an improvement in thoracic and lumbar sagittal alignment, not correction for coronal deformity.
... Por exemplo, as alterações nos parâmetros sagitais cervicais foram significativas após a correção da deformidade em pacientes com EIA. Outras relações significativas entre os parâmetros radiográficos pós-operatórios e a qualidade de vida na inclinação de T1 e eixo vertical sagital de C2-C7 foram considerados preditores de melhor qualidade de vida (Youn, 2016). ...
Introdução: A Escoliose Idiopática do Adolescente (EIA) é a forma mais comum de escoliose idiopática. O tratamento cirúrgico da EIA tem o objetivo de diminuir a progressão da curvatura, preservar a função pulmonar e minimizar as alterações degenerativas da coluna vertebral. Entretanto há muitas variáveis que podem impactar na qualidade de vida nos pacientes com EIA após a cirurgia. Objetivo: Revisar os principais resultados relacionados à qualidade de vida após tratamento cirúrgico da Escoliose Idiopática do Adolescente. Métodos: Revisão sistemática da literatura. Os critérios de inclusão foram: pesquisa em humanos, estudos clínicos, prospectivos e estudos relacionados à qualidade de vida após cirurgia como tratamento da EIA. Os descritores de busca foram "Scoliosis", "Orthopedic Procedures", "Surgical Procedures, Operative", "Quality of Life". Resultados: Foram incluídos 33 artigos, sendo 75,75% estudos de coorte. A principal escala utilizada para avaliar a qualidade de vida foi a Scoliosis Research Society (72,72%). Foi evidenciado uma melhora nos parâmetros de qualidade de vida, autoimagem, satisfação e funcionalidade ao se comparar o pré-operatório com o pós-operatório. As diferentes abordagens cirúrgicas não parecem ter diferenças entre si em relação a tais achados. Conclusão: Existem poucos estudos com alto nível de evidência científica relacionado ao estudo de qualidade de vida após a correção cirúrgica da EIA. A qualidade de vida implica diretamente na função social e saúde psicológica, interferindo na melhor recuperação e sobrevida de pacientes com EIA.
... The cervical alignment is an important factor in the reconstruction of the CVJ. Many studies have revealed the correlation between cervical alignment parameters and the healthrelated quality of life (HRQOL) outcomes such as the neck disability index (NDI) 22,[27][28][29] . It was suggested that the positive sagittal malalignment in cervical spine after surgical treatment would increase the risks of severe disability 30 . ...
Objective:
To investigate the cervical alignment and the relative range of motion (ROM) in patients with basilar invagination (BI).
Methods:
A total of 40 BI cases (38.1 years old ± 17.9 years old, 19 male and 21 female) and 80 asymptomatic individuals (33.8 years old ± 10.8 years old, 40 male and 40 female) were included. The Skull-C2 /Skull-BV, Skull-C7 , C2 -C7 /BV-C7 wall angles, C0 -C2 /C0 -BV, C0 -C7 , C1 -C7 , and C2 -C7 /BV-C7 angles were measured in dynamic X-ray images (including neutral, extension, and flexion positions). Correlation between the upper and lower cervical curvatures were analyzed. The total, extension, and flexion ROMs of these angles were calculated, respectively.
Results:
The BI patients had a smaller C0 -C2 /C0 -BV angle (18.2° ± 16.4° vs 30.9° ± 9.3°), but larger C2 -C7 /BV-C7 (32.2° ± 16.1° vs 19.4° ± 10.6°) and C2 -C7 /BV-C7 wall angles (37.8° ± 17.2° vs 23.6° ± 10.2°) than the control group in neutral position. The upper and lower curvatures correlated negatively in neutral (r = -0.371), extension (r = -0.429), and flexion (r = -0.648) positions among BI patients, as well as in extension position (r = -0.317) among control group. The BI patients presented smaller total ROMs in Skull-C2 /Skull-BV (12.3° ± 16.6° vs 19.7° ± 10.9°), C0 -C2 /C0 -BV (8.1° ± 11.1° vs 17.6° ± 10.5°), and C0 -C7 angles (57.8° ± 14.2° vs 78.3° ± 17.9°), but a larger total ROM in C2 -C7 /BV-C7 wall angle (52.8° ± 13.9° vs 27.0° ± 16.1°) than the control group. The BI patients also presented smaller extension ROMs in Skull-C2 /Skull-BV (6.9° ± 9.4° vs 12.5° ± 9.3°), Skull-C7 (24.5° ± 10.9° vs 30.7° ± 12.5°), and C0 -C2 /C0 -BV angles (4.4° ± 7.8° vs 9.9° ± 8.6°) than the control group. Moreover, the BI patients showed smaller absolute values of flexion ROMs in Skull-C2 /Skull-BV (-5.2° ± 9.4° vs -7.3° ± 8.0°), C0 -C2 /C0 -BV (-3.2° ± 8.8° vs -7.7° ± 8.7°), and C0 -C7 angles (-33.2° ± 13.0° vs -52.8° ± 19.2°), but a larger absolute value of flexion ROM in C2 -C7 /BV-C7 wall angle (-33.9° ± 14.8° vs -8.2° ± 15.1°).
Conclusion:
The cervical spine was stiffer in BI patients than the asymptomatic individuals, especially in the upper cervical curvature. The negative correlation between upper and lower cervical curvatures was more obvious in BI patients.
... 3,4 Several studies reported that the postoperative changes of cervical sagittal parameters were closely related to the quality of life. 5,6 Meanwhile, it was pointed out that the larger preoperative T1S significantly increased the kyphotic changes of posterior laminoplasty. 7 Therefore, sagittal balance must be considered before spinal surgery. ...
Study Design
Observational study
Objective
As an important consideration of surgery, cervical sagittal balance is believed to be better assessed using standing radiograph than supine magnetic resonance imaging (MRI). However, few studies have researched this. Our study aimed to observe the correlations and differences in cervical sagittal parameters between radiograph and MRI in patients with cervical spondylotic myelopathy (CSM), and evaluate whether the change of position affects them.
Methods
We analyzed 84 patients, measuring Cobb angle (CA), T1 slope (T1S), neck tilt (NT), and thoracic inlet angle (TIA). Inter- and intra-parameter analyses were performed to identify any difference between standing radiograph and supine MRI. Statistical correlations and differences between the parameters were compared.
Results
There were excellent inter-observer agreement for each parameter (interclass correlation coefficient >.75), and significant differences were observed in each parameter between radiograph and magnetic resonance imaging ( P < .05). Strong correlations were noted between the same parameters in radiograph and MRI. Cobb angle, T1S, and neck tilt were significantly correlated with thoracic inlet angle on both radiograph and MRI, and CA was significantly correlated with T1S on both radiograph and MRI ( r: −1.0 to −.5 or .5 to 1.0).
Conclusion
Supine MRI obviously underestimated the value of CA, T1S, and TIA. Therefore, standing cervical radiographs should be obtained in CSM patients to assess and determine surgical strategy, not only supine MRI. Moreover, we observed that NT and TIA were not constant morphological parameters.
... In AIS patients, frequent long-term neck pain after scoliosis surgery is correlated with sagittal cervical alignment [10,11] and a significant relationship is found between postoperative cervical sagittal parameters and HRQOL scores [12]. ...
PurposeThe modification of cervical lordosis (CL) after adolescent idiopathic scoliosis (AIS) surgery is influenced by the correction of thoracic hypokyphosis. The quantification of the increase of CL as a function of the increase of thoracic kyphosis (TK) has never been calculated.MethodsA total of 92 consecutive AIS patients who underwent a posterior thoracic selective fusion, corrected by simultaneous translation on 2 rods technique, with minimum 24-month follow-up, were analyzed from a prospective database. We evaluated global sagittal kyphosis and lordosis. CL was divided by the horizontal line in proximal (PCL) and distal cervical lordosis (DCL), likewise TK in proximal (PTK) and distal TK (DTK), and lumbar lordosis (LL) in proximal (PLL) and distal LL (DLL).ResultsThe mean TK gain was 16°, 14° and 28° in the whole cohort, normokyphosis group and hypokyphosis group, respectively. The mean DCL gain was, respectively, 9°, 7° and 20° and the mean CL gain 8°, 5° and 21°. There was a strong correlation between TK gain and CL gain (coefficient = 0.86) and between TK gain and DCL gain (coefficient = 0.74). The regression equation was defined as DCLgain = − 3 + 0.75 × TKgain (p < 0.0001) corresponding on average to 60% of the TK gain.
Conclusion60% of the TK gain was transferred to DCL gain. Correlations reflect the geometrical equivalence between PTK and DCL. The use of sagittal global measurements shows that DCL is equivalent to PTK and can be expressed as a function of pelvic parameters (DCL = PT + LL-PI). DCL must be considered to optimize the postoperative sagittal alignment of the spine.
