Relationship between cervical curvature index (Ishihara) and cervical spine angle (C2–7)

Takeshita, Katsushi; Murakami, Masaya; Kobayashi, Akira; Nakamura, Chiyuki

doi:10.1007/s007760100038

Cited by 76 publications

(51 citation statements)

References 15 publications

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“…Cervical sagittal balance (lordosis) was measured by Ishihara's index. A negative value of Ishihara's index indicates kyphosis and a positive value indicates lordosis [49]. Computerized tomography and SPECT scans were not routinely obtained to evaluate bone fusion.…”

Section: Methodsmentioning

confidence: 99%

Comparison between anterior cervical discectomy fusion and cervical corpectomy fusion using titanium cages for reconstruction: analysis of outcome and long-term follow-up

et al. 2009

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Retrospective comparative study of 80 consecutive patients treated with either anterior cervical discectomy fusion (ACDF) or anterior cervical corpectomy fusion (ACCF) for multi-level cervical spondylosis. To compare clinical outcome, fusion rates, and complications of anterior cervical reconstruction of multi-level ACDF and single-/multi-level ACCF performed using titanium mesh cages (TMCs) filled with autograft and anterior cervical plates (ACPs). Reconstruction of the cervical spine after discectomy or corpectomy with titanium cages filled with autograft has become an acceptable alternative to both allograft and autograft; however, there is no data comparing the outcome of multi-level ACDF and single-/multi-level ACCF using this reconstruction. We evaluated 80 consecutive patients who underwent surgery for the treatment of multi-level cervical spondylosis at our institution from 1998 to 2001. In this series, 42 patients underwent multi-level ACDF (Group 1) and 38 patients underwent ACCF (Group 2). Interbody TMCs and local autograft bone with ACPs were used in both procedures. Medical records were reviewed to assess outcome. Clinical outcome was measured by Odom's criteria. Operative time and blood loss were noted. Radiographs were obtained at 6 and 12 weeks, 6 months, 1 year, and 2 years (if necessary). Early hardware failures and pseudarthroses were noted. Cervical sagittal curvature was measured by Ishihara's index at 1 year. Group 1 had a mean age 46.2 years (range 35-60 years). Group 2 had a mean age 50.1 years (range 35-70 years).The operative time was significantly lower (P \ 0.001) and blood loss significantly higher (P \ 0.001) in Group 2 than in Group 1. At a minimum of 1 year follow up, patients in both groups had equivalent improvement in their clinical symptoms. The fusion rates for Group 1 were 97.6 and 92.1% for Group 2. The rates of early hardware failure were higher in Group 2 (2.6%) than in Group 1 (0%). The fusion rates for Group 1 were not significantly higher than Group 2 (P [ 0.28). There was one patient in Group 1 and 2 patients in Group 2 with pseudarthroses. Complication rates in Group 2 were not significantly higher (P [ 0.341). Cervical lordosis was well-maintained (80%) in both groups. Both multi-level ACDF and ACCF with anterior cervical reconstruction using TMC filled with autograft and ACP for treatment of multi-level cervical spondylosis have high fusion rates and good clinical outcome. However, there is a higher rate of early hardware failure and pseudarthroses after ACCF than ACDF. Hence, in the absence of specific pathology requiring removal of vertebral body, multi-level ACDF using interbody cages and autologous bone graft could result in lower morbidity.

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Section: Methodsmentioning

confidence: 99%

Comparison between anterior cervical discectomy fusion and cervical corpectomy fusion using titanium cages for reconstruction: analysis of outcome and long-term follow-up

et al. 2009

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“…15 The Ishihara index is a validated method of cervical curvature measurement. It is a nondimensional index that correlates with the area surrounded by the C2-7 posterior vertebral line and the line connecting the posterior-inferior edges of C-2 and C-7.…”

Section: 1314mentioning

confidence: 99%

Cervical interfacet spacers and maintenance of cervical lordosis

Tan¹,

Straus²,

Traynelis³

2015

SPI

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OBJECT The cervical interfacet spacer (CIS) is a relatively new technology that can increase foraminal height and area by facet distraction. These offer the potential to provide indirect neuroforaminal decompression while simultaneously enhancing fusion potential due to the relatively large osteoconductive surface area and compressive forces exerted on the grafts. These potential benefits, along with the relative ease of implantation during posterior cervical fusion procedures, make the CIS an attractive adjuvant in the management of cervical pathology. One concern with the use of interfacet spacers is the theoretical risk of inducing iatrogenic kyphosis. This work tests the hypothesis that interfacet spacers are associated with loss of cervical lordosis. METHODS Records from patients undergoing posterior cervical fusion at Rush University Medical Center between March 2011 and December 2012 were reviewed. The FacetLift CISs were used in all patients. Preoperative and postoperative radiographic data were reviewed and the Ishihara indices and cervical lordotic angles were measured and recorded. Statistical analyses were performed using STATA software. RESULTS A total of 64 patients were identified in whom 154 cervical levels were implanted with machined allograft interfacet spacers. Of these, 15 patients underwent anterior-posterior fusions, 4 underwent anterior-posterior-anterior fusions, and the remaining 45 patients underwent posterior-only fusions. In the 45 patients with posterior-only fusions, a total of 110 levels were treated with spacers. There were 14 patients (31%) with a single level treated, 16 patients (36%) with two levels treated, 5 patients (11%) with three levels treated, 5 patients (11%) with four levels treated, 1 patient (2%) with five levels treated, and 4 patients (9%) with six levels treated. Complete radiographic data were available in 38 of 45 patients (84%). On average, radiographic follow-up was obtained at 256.9 days (range 48–524 days). There was no significant difference in the Ishihara index (5.76 preoperatively and 6.17 postoperatively, p = 0.8037). The analysis had 80% power to detect a change of 4.25 in the Ishihara index at p = 0.05. There was no significant difference in the preand postoperative cervical lordotic angles (35.6° preoperatively and 33.6° postoperatively, p = 0.2678). The analysis had 80% power to detect a 7° change in the cervical lordotic angle at p = 0.05. The ANOVA of the Ishihara index and cervical lordotic angle did not show a statistically significant difference in degree of change in cervical lordosis among patients with a different number of levels of CIS insertion (p = 0.25 and p = 0.96, respectively). CONCLUSIONS In the authors' experience of placing CISs in more than 100 levels, they found no evidence of significant loss of cervical lordosis. The long-term impacts of these implants on fusion rates and clinical outcomes (particularly radiculopathy and postoperative C-5 palsies) remain active areas of interest and fertile ground for further studies.

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“…In the recent literature, there are 4 primary radiographic line drawing methods for measurement of cervical lordosis that have reliability, normative data, and predictive validity (ability to discriminate between healthy and abnormal patient populations). These 4 methods are (1) Harrison posterior tangent method, 8,11,16,31 (2) Ishihara's index, 7,32 (3) the area under the curve, 12 and (4) Cobb method. 9,14,31 In the current study, we choose the Harrison posterior tangent and Ishihara's index because these fit two criteria: the method must be established and readily available for clinical use, and second, the method must be able to be performed in a similar manner on the flexicurve tracing.…”

Section: Discussionmentioning

confidence: 99%

“…When summing depths of the cervical lordosis and dividing by the height of the column on the radiograph, it is termed the modified Ishihara's index. 32 From the digitized points along the flexicurve tracing, a best-fit circle was created, and using the center of this circle, the angle of curvature and radius of curvature were calculated.…”

Section: Methodsmentioning

confidence: 99%

Concurrent Validity of Flexicurve Instrument Measurements: Sagittal Skin Contour of the Cervical Spine Compared With Lateral Cervical Radiographic Measurements

Harrison¹,

Haas

Cailliet

et al. 2005

Journal of Manipulative and Physiological Therapeutics

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Relationship between cervical curvature index (Ishihara) and cervical spine angle (C2–7)

Cited by 76 publications

References 15 publications

Comparison between anterior cervical discectomy fusion and cervical corpectomy fusion using titanium cages for reconstruction: analysis of outcome and long-term follow-up

Comparison between anterior cervical discectomy fusion and cervical corpectomy fusion using titanium cages for reconstruction: analysis of outcome and long-term follow-up

Cervical interfacet spacers and maintenance of cervical lordosis

Concurrent Validity of Flexicurve Instrument Measurements: Sagittal Skin Contour of the Cervical Spine Compared With Lateral Cervical Radiographic Measurements

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