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Factors determining cervical spine sagittal balance in asymptomatic adults: correlation with spinopelvic balance and thoracic inlet alignment.
Spine J. 2015 Apr 01; 15(4):705-12.SJ

Abstract

BACKGROUND CONTEXT

Based on the previous studies, cervical lordosis (CL) is a parameter influenced by thoracic kyphosis (TK); however, the correlations still remain unclear. Few studies have analyzed the correlations between the cervical spine lordosis and global spinopelvic balance. To date, there has been no study focused on the factors determining cervical spine sagittal balance.

PATIENT SAMPLE

Seventy-seven asymptomatic volunteers without the history of symptoms related to whole spine.

OUTCOME MEASURES

Statistical significance of correlations of radiographic parameters on cervical spine and whole-spine standing lateral radiograph.

PURPOSE

To analyze the factors determining cervical spine sagittal balance, including global spinopelvic balance and thoracic inlet (TI) alignment in asymptomatic adults.

STUDY DESIGN

A prospective radiographic study.

METHODS

Cervical and whole-spine standing lateral radiographs were taken to analyze the following parameters: spinopelvic parameters pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL), and TK; TI parameters thoracic inlet angle (TIA) and T1 slope; and cervical spine parameters C0-C2, C2-C7, and C0-C7 angles and cervical tilting. Statistical analysis was performed using the Pearson correlation coefficients and multiple regression analysis.

RESULTS

All the parameters showed a normal distribution. There was a significant sequential linkage between PI and SS (r=0.653), SS and LL (r=0.807), LL and TK (r=-0.516), and TK and C0-C7 angle (r=-0.322). There was a significant relationship between TK and T1 slope (r=0.351) but no significant relationship between TK and TIA. There were significant sequential relationships between TIA and T1 slope (r=0.694), T1 slope and C2-C7 angle (r=-0.624), and C2-C7 and C0-C2 angles (r=-0.547). T1 slope was the only parameter that demonstrated a significant correlation with both SP and TI parameters. A linear regression model showed that T1 slope had a stronger relationship with TIA (r=0.694) than TK (r=0.351).

CONCLUSIONS

T1 slope was a key factor determining cervical spine sagittal balance. Both spinopelvic balance and TI alignment have a significant influence on cervical spine sagittal balance via T1 slope, but TIA had a stronger effect than TK. An individual with large T1 slope required large CL to preserve physiologic sagittal balance of the cervical spine. The results of the present study could serve as baseline data for further studies on the cervical spine sagittal balance in various clinical conditions including the surgical reconstruction of lordosis.

Authors+Show Affiliations

Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, #149, Sangil-dong, Gangdong-gu, Seoul 134-727, Korea. Electronic address: shl6@khu.ac.kr.Kei Myung University, #56 Dalseong-RO, Jung-Gu, Daegu, Korea 700-712.Hallym University, Chuncheon Sacred Heart Hospital, #153, Gyo-dong, Chuncheon, Gangwon-do 200-060, Korea.Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, #149, Sangil-dong, Gangdong-gu, Seoul 134-727, Korea.Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, #149, Sangil-dong, Gangdong-gu, Seoul 134-727, Korea.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24021619

Citation

Lee, Sang-Hun, et al. "Factors Determining Cervical Spine Sagittal Balance in Asymptomatic Adults: Correlation With Spinopelvic Balance and Thoracic Inlet Alignment." The Spine Journal : Official Journal of the North American Spine Society, vol. 15, no. 4, 2015, pp. 705-12.
Lee SH, Son ES, Seo EM, et al. Factors determining cervical spine sagittal balance in asymptomatic adults: correlation with spinopelvic balance and thoracic inlet alignment. Spine J. 2015;15(4):705-12.
Lee, S. H., Son, E. S., Seo, E. M., Suk, K. S., & Kim, K. T. (2015). Factors determining cervical spine sagittal balance in asymptomatic adults: correlation with spinopelvic balance and thoracic inlet alignment. The Spine Journal : Official Journal of the North American Spine Society, 15(4), 705-12. https://doi.org/10.1016/j.spinee.2013.06.059
Lee SH, et al. Factors Determining Cervical Spine Sagittal Balance in Asymptomatic Adults: Correlation With Spinopelvic Balance and Thoracic Inlet Alignment. Spine J. 2015 Apr 1;15(4):705-12. PubMed PMID: 24021619.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Factors determining cervical spine sagittal balance in asymptomatic adults: correlation with spinopelvic balance and thoracic inlet alignment. AU - Lee,Sang-Hun, AU - Son,Eun-Seok, AU - Seo,Eun-Min, AU - Suk,Kyung-Soo, AU - Kim,Ki-Tack, Y1 - 2013/09/08/ PY - 2012/07/26/received PY - 2013/05/08/revised PY - 2013/06/17/accepted PY - 2013/9/12/entrez PY - 2013/9/12/pubmed PY - 2015/10/20/medline KW - Cervical spine sagittal balance KW - Spinopelvic balance KW - T1 slope KW - Thoracic inlet alignment SP - 705 EP - 12 JF - The spine journal : official journal of the North American Spine Society JO - Spine J VL - 15 IS - 4 N2 - BACKGROUND CONTEXT: Based on the previous studies, cervical lordosis (CL) is a parameter influenced by thoracic kyphosis (TK); however, the correlations still remain unclear. Few studies have analyzed the correlations between the cervical spine lordosis and global spinopelvic balance. To date, there has been no study focused on the factors determining cervical spine sagittal balance. PATIENT SAMPLE: Seventy-seven asymptomatic volunteers without the history of symptoms related to whole spine. OUTCOME MEASURES: Statistical significance of correlations of radiographic parameters on cervical spine and whole-spine standing lateral radiograph. PURPOSE: To analyze the factors determining cervical spine sagittal balance, including global spinopelvic balance and thoracic inlet (TI) alignment in asymptomatic adults. STUDY DESIGN: A prospective radiographic study. METHODS: Cervical and whole-spine standing lateral radiographs were taken to analyze the following parameters: spinopelvic parameters pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL), and TK; TI parameters thoracic inlet angle (TIA) and T1 slope; and cervical spine parameters C0-C2, C2-C7, and C0-C7 angles and cervical tilting. Statistical analysis was performed using the Pearson correlation coefficients and multiple regression analysis. RESULTS: All the parameters showed a normal distribution. There was a significant sequential linkage between PI and SS (r=0.653), SS and LL (r=0.807), LL and TK (r=-0.516), and TK and C0-C7 angle (r=-0.322). There was a significant relationship between TK and T1 slope (r=0.351) but no significant relationship between TK and TIA. There were significant sequential relationships between TIA and T1 slope (r=0.694), T1 slope and C2-C7 angle (r=-0.624), and C2-C7 and C0-C2 angles (r=-0.547). T1 slope was the only parameter that demonstrated a significant correlation with both SP and TI parameters. A linear regression model showed that T1 slope had a stronger relationship with TIA (r=0.694) than TK (r=0.351). CONCLUSIONS: T1 slope was a key factor determining cervical spine sagittal balance. Both spinopelvic balance and TI alignment have a significant influence on cervical spine sagittal balance via T1 slope, but TIA had a stronger effect than TK. An individual with large T1 slope required large CL to preserve physiologic sagittal balance of the cervical spine. The results of the present study could serve as baseline data for further studies on the cervical spine sagittal balance in various clinical conditions including the surgical reconstruction of lordosis. SN - 1878-1632 UR - https://www.unboundmedicine.com/medline/citation/24021619/Factors_determining_cervical_spine_sagittal_balance_in_asymptomatic_adults:_correlation_with_spinopelvic_balance_and_thoracic_inlet_alignment_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1529-9430(13)00745-6 DB - PRIME DP - Unbound Medicine ER -