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Cervical sagittal alignment in idiopathic scoliosis treated by posterior instrumentation and in situ bending.
Spine (Phila Pa 1976). 2015 Apr 01; 40(7):E419-27.S

Abstract

STUDY DESIGN

Retrospective radiographical analysis of cervical and thoracolumbar sagittal alignment in young adults with idiopathic scoliosis.

OBJECTIVE

To analyze cervical alignment types, the relationship between cervical and thoracolumbar alignment and the effect of posterior instrumentation.

SUMMARY OF BACKGROUND DATA

Thoracic scoliosis with hypokyphosis may decrease cervical lordosis. Additional adaptive positional changes of the mobile cervical segment may exist, because sigmoid cervical patterns are observed. Sagittal alignment of the instrumented thoracolumbar spine may influence cervical alignment.

METHODS

Pre- and postoperative full-spine radiographs of 52 patients were analyzed at 8-year average follow-up. Sagittal thoracolumbar measurements were T1 slope, T1-T4 kyphosis, T4-T12 kyphosis, L1-S1 lordosis, pelvic incidence, pelvic tilt, sacral slope, sagittal vertical axis (SVA) C7, and SVA C2. Cervical measurements were C0-C2, C2-C6, C2-C4, C4-C6, and C2-T1 lordosis, chin-brow vertical angle.

RESULTS

Five cervical alignment types were identified: lordotic, hypolordotic, kyphotic, sigmoid with cranial lordosis, and sigmoid with cranial kyphosis. Spinopelvic parameters and global thoracolumbar balance remained unchanged postoperatively. The average C2-C6 lordosis increased by 6.4° (P < 0.0001). Twenty-seven of the 52 patients changed cervical alignment postoperatively. SVA C2-C7 difference changed in this subgroup (P = 0.0159). In 21 of the 27 patients, SVA changed more than 5 mm at C2 (P = 0.0029), and in 25 of the 27 patients at C7 (P < 0.0001). A correlation existed between T4-T12 kyphosis and L1-S1 lordosis, C2-C4 and L1-S1 lordosis, L1-S1 lordosis, and pelvic tilt. T1-T4 kyphosis and T1 slope correlated with C2-T1 lordosis, but proximal junctional kyphosis was not linked to a specific cervical alignment type.

CONCLUSION

Postoperative adaptive changes occurred at C7 and C2 by shifting anteriorly or posteriorly, resulting in different radiographical cervical shapes. The amount of lumbar lordosis may influence cervical lordosis, which needs to be considered for surgical correction. Adaptive hip movements may influence thoracolumbar and cervical alignment. The amount of proximal thoracic kyphosis influenced cervical lordosis. Global thoracic hypokyphosis might influence cervical alignment, but it was not evidenced.

LEVEL OF EVIDENCE

4.

Authors+Show Affiliations

*Service de Chirurgie du Rachis, and †Service de Sante Publique, Hopitaux Universitaires de Strasbourg, Federation de Medecine Translationnelle (FMTS), Universite de Strasbourg, France.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25902150

Citation

Charles, Yann Philippe, et al. "Cervical Sagittal Alignment in Idiopathic Scoliosis Treated By Posterior Instrumentation and in Situ Bending." Spine, vol. 40, no. 7, 2015, pp. E419-27.
Charles YP, Sfeir G, Matter-Parrat V, et al. Cervical sagittal alignment in idiopathic scoliosis treated by posterior instrumentation and in situ bending. Spine (Phila Pa 1976). 2015;40(7):E419-27.
Charles, Y. P., Sfeir, G., Matter-Parrat, V., Sauleau, E. A., & Steib, J. P. (2015). Cervical sagittal alignment in idiopathic scoliosis treated by posterior instrumentation and in situ bending. Spine, 40(7), E419-27. https://doi.org/10.1097/BRS.0000000000000767
Charles YP, et al. Cervical Sagittal Alignment in Idiopathic Scoliosis Treated By Posterior Instrumentation and in Situ Bending. Spine (Phila Pa 1976). 2015 Apr 1;40(7):E419-27. PubMed PMID: 25902150.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cervical sagittal alignment in idiopathic scoliosis treated by posterior instrumentation and in situ bending. AU - Charles,Yann Philippe, AU - Sfeir,Gergi, AU - Matter-Parrat,Valérie, AU - Sauleau,Erik André, AU - Steib,Jean-Paul, PY - 2015/4/23/entrez PY - 2015/4/23/pubmed PY - 2016/2/19/medline SP - E419 EP - 27 JF - Spine JO - Spine (Phila Pa 1976) VL - 40 IS - 7 N2 - STUDY DESIGN: Retrospective radiographical analysis of cervical and thoracolumbar sagittal alignment in young adults with idiopathic scoliosis. OBJECTIVE: To analyze cervical alignment types, the relationship between cervical and thoracolumbar alignment and the effect of posterior instrumentation. SUMMARY OF BACKGROUND DATA: Thoracic scoliosis with hypokyphosis may decrease cervical lordosis. Additional adaptive positional changes of the mobile cervical segment may exist, because sigmoid cervical patterns are observed. Sagittal alignment of the instrumented thoracolumbar spine may influence cervical alignment. METHODS: Pre- and postoperative full-spine radiographs of 52 patients were analyzed at 8-year average follow-up. Sagittal thoracolumbar measurements were T1 slope, T1-T4 kyphosis, T4-T12 kyphosis, L1-S1 lordosis, pelvic incidence, pelvic tilt, sacral slope, sagittal vertical axis (SVA) C7, and SVA C2. Cervical measurements were C0-C2, C2-C6, C2-C4, C4-C6, and C2-T1 lordosis, chin-brow vertical angle. RESULTS: Five cervical alignment types were identified: lordotic, hypolordotic, kyphotic, sigmoid with cranial lordosis, and sigmoid with cranial kyphosis. Spinopelvic parameters and global thoracolumbar balance remained unchanged postoperatively. The average C2-C6 lordosis increased by 6.4° (P < 0.0001). Twenty-seven of the 52 patients changed cervical alignment postoperatively. SVA C2-C7 difference changed in this subgroup (P = 0.0159). In 21 of the 27 patients, SVA changed more than 5 mm at C2 (P = 0.0029), and in 25 of the 27 patients at C7 (P < 0.0001). A correlation existed between T4-T12 kyphosis and L1-S1 lordosis, C2-C4 and L1-S1 lordosis, L1-S1 lordosis, and pelvic tilt. T1-T4 kyphosis and T1 slope correlated with C2-T1 lordosis, but proximal junctional kyphosis was not linked to a specific cervical alignment type. CONCLUSION: Postoperative adaptive changes occurred at C7 and C2 by shifting anteriorly or posteriorly, resulting in different radiographical cervical shapes. The amount of lumbar lordosis may influence cervical lordosis, which needs to be considered for surgical correction. Adaptive hip movements may influence thoracolumbar and cervical alignment. The amount of proximal thoracic kyphosis influenced cervical lordosis. Global thoracic hypokyphosis might influence cervical alignment, but it was not evidenced. LEVEL OF EVIDENCE: 4. SN - 1528-1159 UR - https://www.unboundmedicine.com/medline/citation/25902150/Cervical_sagittal_alignment_in_idiopathic_scoliosis_treated_by_posterior_instrumentation_and_in_situ_bending_ L2 - https://doi.org/10.1097/BRS.0000000000000767 DB - PRIME DP - Unbound Medicine ER -