Cervical mismatch: the normative value of T1 slope minus cervical lordosis and its ability to predict ideal cervical lordosis

Staub, Blake N.; Lafage, Renaud; Kim, Hee Jin; Shaffrey, Christopher I.; Mundis, Gregory M.; Hostin, Richard A.; Burton, Douglas C.; Lenke, Lawrence G.; Gupta, Munish C.; Ames, Christopher P.; Klineberg, Eric O.; Bess, Shay; Schwab, Frank J.; Lafage, Virginie

doi:10.3171/2018.5.spine171232

Cited by 72 publications

(65 citation statements)

References 24 publications

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“…The T1 slope is the only value that links both the cervical and thoracic spine. It shows a close correlation with thoracic kyphosis, TIA, and C2-7 SVA [26] . C2-7SVA is believed to be another important indicator of cervical sagittal balance [20,21] .…”

Section: Discussionmentioning

confidence: 64%

“…Staub et al reviewed the relationship between T1 slope and cervical lordosis in 103 adult patients with spinal deformity. They found that the T1 slope minus cervical lordosis ranging from 14.5° to 26.5° could maintain the horizontal balance [26] . For this reason, C2-7 SVA should be within the normal range if cervical lordosis is high or the T1 slope is low.…”

Section: Discussionmentioning

confidence: 99%

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Impact of cervical sagittal parameters on axial neck pain in patients with cervical kyphosis

Zhang

Shen

2020

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Background: Cervical sagittal alignment (CSA) is closely related with cervical disc degeneration and impacts the spinal function, especially in the setting of cervical kyphosis (CK). In this study, we evaluated the influence of cervical sagittal parameters on the development of axial neck pain (ANP) in patients with CK.Methods: Data pertaining to 263 patients with CK who visited the outpatient department of our hospital between January 2012 and December 2018 were retrospective analyzed. The most common symptoms of ANP were neck pain, stiffness, or dullness. Visual analogue scale (VAS) was used to evaluate ANP. The following radiographic parameters were evaluated: CK types, C2-7 sagittal vertical axis (SVA), thoracic inlet angle (TIA), T1 slope, neck tilt (NT), cranial tilt, and cervical tilt. Sagittal alignment of CK was classified into 2 types: global and regional type. Multivariate logistic regression analysis was performed to identify risk factors for ANP.Results: Patients who complained of ANP were categorized as ANP group (VAS score≥3; n=92), while those without ANP were categorized as non-ANP group (VAS score<3; n=171). There was no significant between-group difference with respect to age (P=0.196), gender (P=0.516), TIA (P=0.139), NT (P=0.676), CK type (P=0.533), cranial tilt (P=0.332), cervical tilt (P=0.585), or cervical disc degeneration (P=0.695). The T1 slope and C2-7 SVA in the ANP group was significantly greater than that in the non-ANP group (P < 0.05). On multivariate logistic regression, C2-7 SVA [odds ratio (OR) 2.318, 95% confidence interval 1.373–4.651, P=0.003) and T1 slope (OR 2.563, 95% CI 1.186–4.669, P=0.028) were identified as risk factors for ANP.Conclusions: Our findings suggest a significant effect of cervical sagittal parameters on the occurrence of ANP in patients with CK. Greater T1 slope and larger C2-7 SVA may lead to the development of neck pain.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Impact of cervical sagittal parameters on axial neck pain in patients with cervical kyphosis

Zhang

Shen

2020

Preprint

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“…The T1 slope has been the only value linking both the cervical and thoracic spine. It has closely correlation with thoracic kyphosis, TIA and C2-7 SVA [26] . A higher thoracic kyphosis often results in a higher T1 slope [21] ..…”

Section: Discussionmentioning

confidence: 77%

“…Then, it implied that the T1 slope minus cervical lordosis ranged form 14.5°to 26.5°could maintain the horizontal balance. [26] . In our study, the multivariate logistic regression analysis showed T1 slope was the risk factor of ANP.…”

Section: Discussionmentioning

confidence: 99%

The impact of cervical sagittal parameters on axial neck pain in patients with cervical kyphosis

Zhang

Shen

2020

Preprint

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Background:Cervical sagittal alignment is closely related with cervical disc degeneration and impacts the spinal function and quality of life, especially for cervical kyphosis (CK). The purpose of this study was to evaluate the influence of cervical sagittal parameters on the axial neck pain (ANP) in patients with CK.Methods: A retrospective analysis was performed of data from 263 patients who underwent to the authors' department of this institution between January 2012 and December 2018. Radiographic evaluations were performed at authors' department, including CK types, C2-7 sagittal vertical axis (SVA), thoracic inlet angle (TIA), T1 slope, neck tilt (NT), cranial tilt and cervical tilt. Sagittal alignment of the cervical spine was classified into 2 types: global and regional type. Multivariate logistic regression analysis was performed to evaluate these parameters as the risk factors for ANP.Results: Patients in this study were divided into 2 groups according to ANP. There were 92 patients in ANP group and 171 patients in Non-ANP group. There was no significant difference in age (P=0.196), gender (P=0.516), TIA(P=0.139), NT (P=0.676), CK types (P=0.533), cranial tilt (P=0.332), cervical tilt (P=0.585) and cervical disc degeneration (P=0.695) between the two groups. T1 slope, C2-7 SVA in the ANP group was significantly higher than in the Non-ANP group (P < 0.05). After multivariate logistic regression analysis, C2-7 SVA (P=0.003, OR 2.318, 95% CI 1.373-4.651) and T1 slope (P=0.028, OR 2.563, 95% CI 1.186-4.669) were the two risk factors for the ANP.Conclusions: Based on this study, cervical sagittal parameters have a significant effect on the happening of axial neck pain in patients with CK. A higher T1 slope and larger C2-7 SVA are closely lead to the development of neck pain. BackgroundCervical sagittal imbalance is the one of the main reasons for decreased intervertebral disc height, further leads to the cervical degenerative disease [1, 2] . The misalignment exacerbates more distribution of the load on the intervertebral disc and posterior joints, accelerates the progression of spinal degenerative diseases during the range of motion. However, there is limited data exploring the relationship between cervical sagittal alignment and axial neck pain(ANP). JL carried out the manuscript preparation and experimental design, DZ conducted patient visits and statistical analysis of the data. JL and DZ carried out the statistical analysis of the data.YS revised the manuscript critically for important intellectual content and gave final approval of the version to be published.All authors read and approved the final version of this manuscript. Authors' information

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“…The reasonable range of C2-C7 SVA of 29.2 mm corresponded to T1S-CL of 20.7° is narrower than posterior cervical fusion reported by Hyun et al, which emphasizes the different threshold in various approaches. Staub et al [26] implied normative CL can be predicted via T1S-CL= 16.5° ± 2° based on 103 patients with cervical spine deformity. It is considered that there were differences between anterior and posterior approach on surgical-indications, internal-xtions, posterior muscle striping and preservation of ligament complex, where the solid xtion by lateral mass screw and bowstring effect from posterior muscle requires wider range of T1SCL [5,27].…”

Section: Discussionmentioning

confidence: 99%

T1 slope minus cervical lordosis in multilevel anterior cervical discectomy and fusion with or without plate: a mean 6-year follow up

Yang

Liu

et al. 2020

Preprint

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Purpose Cervical alignment between self-locked cage (SLC) and anterior cage-with-plate (ACP) system was debatable, especially in multilevel anterior cervical discectomy and fusion (ACDF). T1 slope minus C2-C7 cervical lordosis (T1S-CL) was critical for cervical-balance while without identified threshold. Thus the study was to compare sagittal alignment between SLC and ACP on 3-level ACDF and to identify the threshold of T1S-CL in 3-level ACDF. Methods 45 patients of 3-level SLC and 28 cases of 3-level ACP with well-matched demographics were retrospectively enrolled with 6.1-year follow-up. Cervical alignment paramters were CL, C2-C7 sagittal vertical axis (C2-C7 SVA), T1S and T1S-CL, as well as adjacent segment degeneration (ASD), obtained on X-ray. Neck disability index (NDI) and Japanese Orthopedic Association (JOA) score were recorded for evaluating quality of life (QOL). NDI of 20 was difined as the cutoff of QOL. Threshold of T1S-CL was determined by both linear and logistic regression model. Result CL, C2-C7 SVA and T1S were insignificant at baseline and all parameters were indifferent at last (P ˃0.05). CL and T1S improved at last in both groups (P < 0.05). The incidence of ASD was comparable between groups (P ˃0.05). Both groups acquired inprovement on NDI and JOA (P < 0.001). There were close correlation among alignment paramters and between parameters and NDI at final follow-up. C2-C7 SVA was independent risk factor for NDI and two regression models predicted C2-C7 SVA with a cutoff of 29.2 mm, corresponded to the threshold on T1S-CL of 20.7°. Conclusions It is comparable on alignment reconstruction between SLC and ACP system. The cutoff on C2-C7 SVA with 29.2 mm corresponds to a thershold of T1S-CL with 20.7° in multilevel ACDF.

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Cervical mismatch: the normative value of T1 slope minus cervical lordosis and its ability to predict ideal cervical lordosis

Cited by 72 publications

References 24 publications

Impact of cervical sagittal parameters on axial neck pain in patients with cervical kyphosis

Impact of cervical sagittal parameters on axial neck pain in patients with cervical kyphosis

The impact of cervical sagittal parameters on axial neck pain in patients with cervical kyphosis

T1 slope minus cervical lordosis in multilevel anterior cervical discectomy and fusion with or without plate: a mean 6-year follow up

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