Modeling of the Sagittal Cervical Spine as a Method to Discriminate Hypolordosis

Harrison, Donald D.; Harrison, Deed E.; Janik, Tadeusz J.; Cailliet, René; Ferrantelli, Joseph R; Haas, Jason W.; Holland, Burt

doi:10.1097/01.brs.0000144449.90741.7c

Cited by 177 publications

(101 citation statements)

References 34 publications

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“…Normal values of a lordotic curve C2-7 have been reported to be about 24° [41] with a range of 10°-34° [3,38,42,43,81]. In our study, we determined an angle of <10°d enoting a ''hypolordotic'' curvature, and <0°a ''kyphotic'' curvature at last follow-up.…”

Section: Methodsmentioning

confidence: 90%

“…The sagittal plane neutral geometry of the cervical spine is an important biomechanical consideration [43]. A neutral sagittal vertical axis minimizes the muscular effort necessary to maintain an upright posture [3,112].…”

Section: Influence Of Cervical Lordosismentioning

confidence: 99%

“…In a study of Grob et al [41] mean TCL in asymptomatic and symptomatic individuals was 24.3°and 23.0°, respectively. In other surveys, normal TCL ranged between 10°and 34.5° [3,38,42,43,81]. As concerns postsurgical lordosis achieved, Sevki et al [103] reported on successful reconstructions and no loss of sagittal alignment following the use of constrained ACPs, TMC, and posterior arthrodesis in twelve 3-to 4-level corpectomies.…”

Section: Influence Of Cervical Lordosismentioning

confidence: 99%

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4- and 5-level anterior fusions of the cervical spine: review of literature and clinical results

et al. 2007

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In the future, there will be an increased number of cervical revision surgeries, including 4-and more-levels. But, there is a paucity of literature concerning the geometrical and clinical outcome in these challenging reconstructions. To contribute to current knowledge, we want to share our experience with 4-and 5-level anterior cervical fusions in 26 cases in sight of a critical review of literature. At index procedure, almost 50% of our patients had previous cervical surgeries performed. Besides failed prior surgeries, indications included degenerative multilevel instability and spondylotic myelopathy with cervical kyphosis. An average of 4.1 levels was instrumented and fused using constrained (26.9%) and non-constrained (73.1%) screw-plate systems. At all, four patients had 3-level corpectomies, and three had additional posterior stabilization and fusion. Mean age of patients at index procedure was 54 years with a mean follow-up intervall of 30.9 months. Preoperative lordosis C2-7 was 6.5°in average, which measured a mean of 15.6°at last follow-up. Postoperative lordosis at fusion block was 14.4°in average, and 13.6°at last follow-up. In 34.6% of patients some kind of postoperative change in construct geometry was observed, but without any catastrophic construct failure. There were two delayed unions, but finally union rate was 100% without any need for the Halo device. Eleven patients (42.3%) showed an excellent outcome, twelve good (46.2%), one fair (3.8%), and two poor (7.7%). The study demonstrated that anterior-only instrumentations following segmental decompressions or use of the hybrid technique with discontinuous corpectomies can avoid the need for posterior supplemental surgery in 4-and 5-level surgeries. However, also the review of literature shows that decreased construct rigidity following more than 2-level corpectomies can demand 360°instrumentation and fusion. Concerning construct rigidity and radiolographic course, constrained plates did better than non-constrained ones. The discussion of our results are accompanied by a detailed review of literature, shedding light on the biomechanical challenges in multilevel cervical procedures and suggests conclusions.

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Section: Methodsmentioning

confidence: 90%

Section: Influence Of Cervical Lordosismentioning

confidence: 99%

Section: Influence Of Cervical Lordosismentioning

confidence: 99%

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4- and 5-level anterior fusions of the cervical spine: review of literature and clinical results

et al. 2007

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“…Lordotic angle was obtained between superior endplate of S1 and inferior endplate of L1 in the lateral view [20]. Hand line drawn technique was applied on each image while lordotic angles were measured by protractor [24,25]. Five observers independently evaluated each radiograph to determine the modified Cobb angles.…”

Section: Measurementmentioning

confidence: 99%

Evaluation of a lumbosacral orthosis in flexion and extension movements of lumbar spine using Cobb method

Shaari

Osman

2012

2012 International Conference on Biomedical Engineering (ICoBE)

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Lumbosacral orthosis (LSO) is a type of spinal orthosis that has been recommended for three basic purposes; abdominal support, pain management, and motion or positional control [1]. Even though the scientific evidence of its clinical effectiveness is controversial, the use of LSO increases due to a high satisfaction rate among patients with low back pain [2]. By implementation of radiographic technique, objectives of this study are to evaluate the changes of lumbar lordosis in flexion and extension of trunk movements with and without wearing the LSO measured by Cobb technique and to correlate the value of lordotic angles in particular posture. Ten healthy men without any history of low back pain participated and a semi-rigid LSO was utilized.Lateral radiographs of spine images during neutral, flexion and extension postures were captured, with and without orthosis. The lumbar lordosis angle was determined using four lines Cobb technique on each of printed lateral radiographic images. Statistical analysis was completed using Statistical Package for the Social Sciences (SPSS). Mean of lumbar lordosis for maximum trunk flexion with and without orthosis is 12.2° and 16.4° respectively. Lordotic angles for extension are higher than flexion which is 51.7° for maximum trunk extension without orthosis and 54.6° for maximum trunk extension with orthosis. Present results indicate that the lumbar lordosis increased when the lumbosacral orthosis was used in both flexion and extension movements.

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“…Another team has investigated the reliability of line marking on neutral static (no flexion-extension) lateral projection neck radiographs 67 , on antero-posterior projection cervico-dorsal neck radiographs 68 , and then undertook an analysis of whether modeling of the neutral lateral projection radiographs of the cervical spine could discriminate hypolordosis 69 . None of this, however, does other than offer weak clues as to intervertebral kinematics in the neck in the sagittal plane.…”

Section: Introductionmentioning

confidence: 99%

Normal neck motion

Charlton¹

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Musculoskeletal disorders affect humankind perhaps more than any other category of malady, and at all ages. Prominent amongst such disorders are those apparently afflicting the vertebral column presenting with symptoms of headache and neck pain. Diagnosis of the cause of symptoms implicating structures or dysfunction of the neck as source is fraught with difficulty. Local neck joint kinetic behaviour and motion amplitude commands attention from those with an interest in manipulation, like chiropractors and physiotherapists, as well as surgeons, who all commonly examine patients for an association between perceived anomalies of local joint motion and such symptoms.Anecdotal impressions about the significance of findings made in this fashion form the rationale for therapy, including manual therapy.Although there are data on global neck kinematics, studies of local neck joint kinematic behaviour in appropriate age and gender cohorts of sufficient size to be clinically useful are scarce and contradictory. Remarkably, as investigators seek, but have yet to find, reliable and accurate diagnostic tests to quantify local neck joint motion, surgeons also seek surgically without any such data to relieve spondylotic myelopathy and/or radiculopathy caused by mechanical pathology in an intervertebral disc in the cervical spine with insertion of artificial disc prostheses. Thus, for those addressing the causes of otherwise unexplained neck related symptoms, especially surgeons and chiropractors, accurate data and a thorough understanding of neck kinematics (understanding of joint behaviour without consideration of forces) are essential, but absent. This leads to six sets of values of sufficient size for each gender and three age ranges, accounting for inter-observer variation, which no previous study has undertaken in this way. Earlier reports of notional "normal" values for both motion amplitudes and ICR locations appear not to be based on equivalent data.This thesis reveals sufficient differences in values in enough joints for the three different age cohorts representing the commonest age groups presenting with neck pain and related disorders, and in both genders, to render current catalogues of normal motion somewhat unsatisfactory. For normal sagittal plane local joint motion from C2-3 to C6-7 in the human neck, for rotation amplitude values, the Null Hypotheses that no such data in neck kinematics can show differences in values from age cohort to age cohort and/or from gender cohort to gender cohort are rejected. The Null Hypotheses for Instantaneous Axes of Rotation are confirmed.Further, the thesis produces sufficient new evidence to propose more accurate ranges that can be considered as clinically relevant normals as the basis for investigations into clinical causes and assessment of treatment results for mechanically implicated neck pain and related disorders.4

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Modeling of the Sagittal Cervical Spine as a Method to Discriminate Hypolordosis

Cited by 177 publications

References 34 publications

4- and 5-level anterior fusions of the cervical spine: review of literature and clinical results

4- and 5-level anterior fusions of the cervical spine: review of literature and clinical results

Evaluation of a lumbosacral orthosis in flexion and extension movements of lumbar spine using Cobb method

Normal neck motion

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