Characteristics of cervical sagittal parameters in healthy cervical spine adults and patients with cervical disc degeneration

Shen

2020

Preprint

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.

Section: Discussionmentioning

confidence: 87%

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

Shen

2020

Preprint

“…Nevertheless, multivariate logistic regression showed different CK types was not the risk factor for the ANP, in spite of disc degeneration caused by abnormal kinematics. Previous studies demonstrated almost 20% asymptomatic individuals have cervical disc degeneration [28,29] . Therefore, similar to their study, disc degenration was also found in Non-ANP group.…”

Section: Discussionmentioning

confidence: 99%

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

Shen

2020

Preprint

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

“…According to our results, similar results are found in the cervical spine, that is, MC III indicate small sROM and high-level DD grade. However, the patients with MC III have signi cantly smaller CL and C7S than those with MC I, indicating that high-grade DD may be due to the straight cervical spine rather than cervical spine aging [28].…”

Section: II Indicate Unchanged Srom and It Is The Transition Phasementioning

confidence: 94%

“…As the CL, C7S and tDD of the patients with MC I are relatively large (Fig. 4b and 5), the reason why MC I is always accompanied by high-grade DD can be explained by cervical spine aging, because the increase in CL and C7S is considered to be a compensatory change in the aging process of the cervical spine [28].…”

Section: I Indicate Small Srom and Advanced Dd Gradementioning

confidence: 98%

Effect of Different Types of Modic Changes on Segmental Motion and Disc Degeneration in Cervical Spine

Wang

et al. 2020

Preprint

Background: Few studies have reported the segmental motion characteristics of different types of Modic changes (MCs) in the cervical spine in contrast to the lumbar spine. Considering the close relationship between MCs and disc degeneration (DD), this study is designed to elucidate the relationship of MCs with DD and DD-based angular motion in the cervical spine.Methods: MRI of C2/3~C6/7 from 594 patients were reviewed and those with MCs were selected and evaluated. MCs were defined as type 0, I, II, and III, and the grade of DD was classified from A to E (recorded from 1 to 5 points) as previously reported. DD score of each segment (sDD), total sDD of the entire cervical spine (tDD), and VAS score (neck pain) of each patient with MC were also recorded. Cervical lordosis (CL), C7 slope (C7S), segmental angular motion (sROM) and total angular motion of the entire cervical spine (tROM) were calculated from X-ray images.Results: Totally 135 MC segments were evaluated. In the two groups of DD D and DD E, the sROM of MC I and III segments are smaller than that of MC 0 segments, and the sROM of MC II segments are similar to that of MC 0. In addition, MC I segments present smaller sROM than that of MC II in the group of DD E, and their sROM are larger than that of MC III in the group of DD D. No difference is found in tROM between the patients with MC I, II and III. Our results also show that MC I and III segments are associated with high sDD and tDD scores. Finally, the patients with MC I have larger CL and C7S than those with MC III, and there is no statistical difference in VAS scores of neck pain between the patients with MC I, II and III. Conclusions: In the cervical spine, both MC I and III indicate decreased segmental angular motion and high disc degeneration grade. Cervical MCs may not be a sign of unstable neck pain or an indication for interbody fusion.