Characteristics of Cervical Spine Motion in Different Types of Cervical Alignment

Sessumpun, Kittipong; Paholpak, Permsak; Hindoyan, Kevork; Tamai, Katsuto; Sangkomkamhang, Thananit; Buser, Zorica; Wang, Jeffrey C.

doi:10.1097/bsd.0000000000000605

Cited by 10 publications

(5 citation statements)

References 16 publications

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“…As a result, the upper cervical spine was not required to compensate for postoperative subaxial malalignment after ACDF. Sessumpun et al 35 found increased upper cervical spine motion for those with global cervical kyphosis with the mean CL of −8.2 degrees in their patient cohort (compared with 15.9 degrees in the present study). Future research in a cohort with significant cervical spine kyphosis or cSVA > 40 mm may better elucidate these relationships.…”

Section: Discussioncontrasting

confidence: 42%

The Impact of Upper Cervical Spine Alignment on Patient-reported Outcome Measures in Anterior Cervical Decompression and Fusion

Divi

Karamian

Canseco

et al. 2022

Clinical Spine Surgery: A Spine Publication

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Study Design: This was a retrospective cohort study. Objective: To determine the extent to which the upper cervical spine compensates for malalignment in the subaxial cervical spine, and how changes in upper cervical spine sagittal alignment affect patient-reported outcomes. Summary of Background Data: Previous research has investigated the relationship between clinical outcomes and radiographic parameters in the subaxial cervical spine following anterior cervical discectomy and fusion (ACDF). However, limited research exists regarding the upper cervical spine (occiput to C2), which accounts for up to 40% of neck movement and has been hypothesized to compensate for subaxial dysfunction. Materials and Methods: Patients undergoing ACDF for cervical radiculopathy and/or myelopathy at a single center with minimum 1-year follow-up were included. Radiographic parameters including cervical sagittal vertical axis, C0 angle, C1 inclination angle, C2 slope, Occiput-C1 angle (Oc–C1 degrees), Oc–C2 degrees, Oc–C7 degrees, C1–C2 degrees, C1–C7 degrees, and C2–C7 degrees cervical lordosis (CL) were recorded preoperatively and postoperatively. Delta (Δ) values were calculated by subtracting preoperative values from postoperative values. Correlation analysis as well as multiple linear regression analysis was used to determine relationships between radiographic and clinical outcomes. Alpha was set at 0.05. Results: A total of 264 patients were included (mean follow-up 20 mo). C2 slope significantly decreased for patients after surgery (Δ=−0.8, P=0.02), as did parameters of regional cervical lordosis (Oc–C7 degrees, C1–C7 degrees, and C2–C7 degrees; P<0.001, <0.001, and 0.01, respectively). Weak to moderate associations were observed between postoperative CL and C1 inclination (r=−0.24, P<0.001), Oc–C1 degrees (r=0.59, P<0.001), and C1–C2 degrees (r=−0.23, P<0.001). Increased preoperative C1–C2 degrees and Oc–C2 degrees inversely correlated with preoperative SF-12 Mental Composite Score (MCS-12) scores (r=−0.16, P=0.01 and r=−0.13, P=0.04). Cervical sagittal vertical axis was found to have weak but significant associations with Short Form-12 (SF-12) Physical Composite Score (PCS-12) (r=−0.13, P=0.03) and MCS-12 (r=0.12, P=0.05). Conclusion: No clinically significant relationship between upper cervical and subaxial cervical alignment was detected for patients undergoing ACDF for neurological symptoms. Upper cervical spine alignment was not found to be a significant predictor of patient-reported outcomes after ACDF. Level of Evidence: Level III.

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Section: Discussioncontrasting

confidence: 42%

The Impact of Upper Cervical Spine Alignment on Patient-reported Outcome Measures in Anterior Cervical Decompression and Fusion

Divi

Karamian

Canseco

et al. 2022

Clinical Spine Surgery: A Spine Publication

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“…For the overall ROM of the cervical spine (C1-C7), our results showed that the ROM of the kyphosis group increased by approximately 41.2% compared with the normal group during left-right lateral bending movements. Similarly, Sessumpun et al [27] used MRI technology to study the 2D motion of cervical vertebrae with different curvatures and found that the overall ROM in a cervical kyphosis group increased by 38.8% compared with a normal curvature group. Although their results were similar to the present study, data on changes in mobility during left-right rotation and exion-extension movements were not reported separately in the Sessumpun et al study.…”

Section: Discussionmentioning

confidence: 99%

Effect of different cervical curvatures on three-dimensional kinematics under physiological load

Zhang

Zhong

Luo

et al. 2023

Preprint

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Objective: The aim of this study was to measure the 3D motion of cervical vertebra with different curvatures under seven functional postures and investigate the relationship between cervical spine curvatures and the kinematics of each functional motion unit. Methods: Seventy-five volunteers were classified into 5 curvature groups based on the C1-C7 Cobb angle of sagittal alignment. These were: a normal group, straight group, kyphosis group and hyper and hypolordosis groups. All volunteers underwent cervical spine CBCT scans at 7 functional positions. The range-of-motion (ROM) of each vertebra and the overall cervical spine were measured using a 3D-3D registration technique. Results: In comparison to the normal group, the ROM of C3-C4 during left-right twisting in the kyphotic group was significantly higher, while the ROM of C1-C2 during left-right bending was also significantly greater. In addition, the ROM of C5-C6 in the straight group was higher during left-right bending in comparison to the normal group. During flexion-extension, the ROM of C4-C5 in kyphotic subjects was significantly lower than in the normal group, while in the C5-C6 segment, the ROM of the straight and the kyphotic groups was significantly greater compared to the normal group. During left-right bending, the global ROM of kyphotic subjects was higher than in the normal group. Conclusions: 3D kinematics was used to accurately quantify the ROM of cervical spine under different curvatures under physiological load. The data implied that cervical kyphosis may have a greater impact on ROM. Our findings may contribute to prevent cervical spondylosis by early intervention in curvature changes.

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“…Firstly, the sample of both groups were little since only patients with CSM performed 3-level ACDF were enrolled. Then, global cervical alignment was expressed by CL, which could not ideally describe total shapes of cervical spine such as sigmoid-S-type since it might effect the spinal canal volume [ 29 ] and result in a shape-derived symptom. Finally, the conclusion was suitable for 3-level ACDF on CSM but might not for other types such as cervical spondylotic radiculopathy, where the nerve root could be effected by the height of intervertebral foramen result from the change of cervical alignment.…”

Section: Discussionmentioning

confidence: 99%

Cervical spine alignment and clinical outcomes after multilevel anterior cervical decompression and fusion with or without plate

Yan

Xu²,

Yu³

et al. 2021

Medicine

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It was reported imperative on cervical sagittal alignment reconstruction after anterior multilevel procedures with self-locked standalone cage (SSC) or anterior cage-with-plate (ACP) system multilevel while there was little knowledge about the relationship on cervical alignment and clinical outcomes.To identify the importance of cervical sagittal alignment after 3-level anterior cervical discectomy and fusion on cervical spondylotic myelopathy with SSC and ACP system.Seventy-seven patients with SSC system (SSC group) and 52 cases with ACP system (ACP group) from February 2007 to September 2013 were enrolled with well-matched demographics. Cervical alignment included C2-7 lordosis (CL), operatedsegment cervical lordosis (OPCL), upper and lower adjacent-segment cervical lordosis, range of motion of upper and lower adjacent segment at preoperation, immediate postoperation, and the final follow-up. Clinical outcomes contained the neck disability index (NDI), the Japanese Orthopaedic Association (JOA) score, visual analogous scale (VAS) of arm and neck and adjacent segment degeneration (ASD). Patients were then divided into CL improved subgroup (IM subgroup) and non-improved subgroup (NIM subgroup).There were improvements on CL and OPCL in both groups. The change of CL and OPCL larger in ACP group (P < .05) but upper adjacent-segment cervical lordosis/lower adjacent-segment cervical lordosis and range of motion of upper adjacent segment/range of motion of lower adjacent segment were of no significance. NDI, JOA, and VAS got improvement in both groups at immediate postoperation and the final follow-up while ASD was in no difference between SSC and ACP group. A total of 80 patients (39 vs 41) acquired CL improvement with a larger population in ACP group. There were no differences on the rate of ASD, NDI, JOA, VAS, and their change between IM and NIM subgroup. The changes of CL were not correlated to NDI, JOA, VAS, and their change.SSC and ACP group both provide improved OPCL and efficacy on 3-level cervical spondylotic myelopathy with little impact on adjacent segment. The change of CL is not correlated to clinical outcomes.

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Characteristics of Cervical Spine Motion in Different Types of Cervical Alignment

Abstract: Level 3.

Cited by 10 publications

References 16 publications

The Impact of Upper Cervical Spine Alignment on Patient-reported Outcome Measures in Anterior Cervical Decompression and Fusion

The Impact of Upper Cervical Spine Alignment on Patient-reported Outcome Measures in Anterior Cervical Decompression and Fusion

Effect of different cervical curvatures on three-dimensional kinematics under physiological load

Cervical spine alignment and clinical outcomes after multilevel anterior cervical decompression and fusion with or without plate

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