Sagittal balance of the cervical spine: a systematic review and meta-analysis

Azimi, Parisa; Yazdanian, Taravat; Benzel, Edward C.; Hai, Yong; Montazeri, Ali

doi:10.1007/s00586-021-06825-0

Cited by 21 publications

(9 citation statements)

References 121 publications

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“…However, the contradictory findings between the correlation between posture and pain in previous studies might simply be due to a lack of uniform classification and measures; most of the previous research is based on 2D posture analysis and poor experimental design. Further, when taken as a whole, comprehensive literature reviews including systematic literature reviews and meta-analyses on the topic, suggests a correlation between sagittal plane posture and patient outcomes [ 11 , 12 , 15 , 49 , 50 ]; especially in the cervical spine [ 51 , 52 , 53 ].…”

Section: Discussionmentioning

confidence: 99%

Does Improvement towards a Normal Cervical Sagittal Configuration Aid in the Management of Lumbosacral Radiculopathy: A Randomized Controlled Trial

Moustafa

Diab

Harrison

2022

JCM

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A randomized controlled study with a six-month follow-up was conducted to investigate the effects of sagittal head posture correction on 3D spinal posture parameters, back and leg pain, disability, and S1 nerve root function in patients with chronic discogenic lumbosacral radiculopathy (CDLR). Participants included 80 (35 female) patients between 40 and 55 years experiencing CDLR with a definite hypolordotic cervical spine and forward head posture (FHP) and were randomly assigned a comparative treatment control group and a study group. Both groups received TENS therapy and hot packs, additionally, the study group received the Denneroll cervical traction orthotic. Interventions were applied at a frequency of 3 x per week for 10 weeks and groups were followed for an additional 6-months. Radiographic measures included cervical lordosis (CL) from C2–C7 and FHP; postural measurements included: lumbar lordosis, thoracic kyphosis, trunk inclination, lateral deviation, trunk imbalance, surface rotation, and pelvic inclination. Leg and back pain scores, Oswestry Disability Index (ODI), and H-reflex latency and amplitude were measured. Statistically significant differences between the groups at 10 weeks were found: for all postural measures, CL (p = 0.001), AHT (p = 0.002), H-reflex amplitude (p = 0.007) and latency (p = 0.001). No significant difference for back pain (p = 0.2), leg pain (p = 0.1) and ODI (p = 0.6) at 10 weeks were identified. Only the study group’s improvements were maintained at the 6-month follow up while the control groups values regressed back to baseline. At the 6-month follow-up, it was identified in the study group that improved cervical lordosis and reduction of FHP were found to have a positive impact on 3D posture parameters, leg and back pain scores, ODI, and H-reflex latency and amplitude.

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Section: Discussionmentioning

confidence: 99%

Does Improvement towards a Normal Cervical Sagittal Configuration Aid in the Management of Lumbosacral Radiculopathy: A Randomized Controlled Trial

Moustafa

Diab

Harrison

2022

JCM

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“…It has been widely accepted that cervical lordosis plays an important role in maintaining sagittal head and spinal balance [ 34 ]. Compromise on this lordotic curvature of the cervical spine, such as hypolordosis or kyphosis, is usually associated with neck pain, disability, and cervical disc degeneration [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Is the Zero-P Spacer Suitable for 3-Level Anterior Cervical Discectomy and Fusion Surgery in Terms of Sagittal Alignment Reconstruction: A Comparison Study with Traditional Plate and Cage System

et al. 2022

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The Zero-P spacer was primarily developed aiming to reduce the morbidity associated with the traditional anterior cervical plate. During the past decade, many authors have reported the use of Zero-P spacers for anterior cervical discectomy and fusion (ACDF) of one or two segments. Nevertheless, there is still a paucity of knowledge on the safety and feasibility of using Zero-P spacers for 3-level fixation. The objective of this study was to investigate the clinical and radiological outcomes, with a focus on the sagittal alignment reconstruction of 3-level ACDF surgery using Zero-P spacers versus those using a traditional plate and cage system. From Sep 2013 to Aug 2016, a total of 44 patients who received 3-level ACDF surgery due to cervical spondylotic myelopathy were recruited. The Zero-P spacer was used in 23 patients (group ZP) and the traditional plate and cage system in 21 (group PC). Clinical outcomes were analyzed by Neck Disability Index (NDI) and Japanese Orthopedic Association (JOA) scores, and dysphagia was evaluated using the Bazaz score. Radiological outcomes, including fusion rate, adjacent segment degeneration (ASD), and especially changes in cervical sagittal alignment, were analyzed. The NDI and JOA scores did not differ significantly between the two groups postoperatively (p > 0.05); however, there was significantly less dysphagia in patients using Zero-P spacers at the 3- and 6-month follow-up (p < 0.05). At the 24-month follow-up, the fusion rate and ASD were similar between the two groups (p > 0.05). Interestingly, patients using Zero-P spacers had a significantly lower postoperative C2-7 Cobb angle and fused segment Cobb angle, compared to those using a traditional plate and cage system (p < 0.05); meanwhile, the fused segment disc wedge was also found to be significantly smaller in patients using Zero-P spacers after surgery (p < 0.05). Moreover, we further divided patients into subgroups according to their cervical lordosis. In patients with a preoperative C2-7 Cobb angle ≤ 10°, significantly less cervical and local lordosis, as well as disc wedge, were seen in group ZP after surgery (p < 0.05), while in others with a preoperative C2-7 Cobb angle > 10°, no significant difference in postoperative changes of the cervical sagittal alignment was seen between group ZP and group PC (p > 0.05). Zero-P spacers used in 3-level ACDF surgery could provide equivalent clinical outcomes and a lower rate of postoperative dysphagia, compared to the traditional plate and cage system. However, our results showed that it was inferior to the cervical plate in terms of sagittal alignment reconstruction for 3-level fixation. We recommend applying Zero-P spacers for 3-level ACDF in patients with good preoperative cervical lordosis (C2-7 Cobb angle > 10°), in order to restore and maintain physiological curvature of the cervical spine postoperatively.

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“…In general, it has been reported that laminoplasty is not effective for patients with C-OPLL and having cervical spine kyphosis along with high cSVA 7,22 . The clinical review reported the ranges of two sagittal parameters for desired post-operative clinical outcomes: C7 slope, average value 20°, must not be higher than 40° and cSVA must be less than 40 mm (mean value 20 mm) 23 . In this analysis, for extension, both bending and both rotations, the LM-L model only showed decrease in ROM compared to other models.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Laminoplasty on Lordotic, Straight and Kyphotic Cervical Alignments Suggest Poor Outcomes for Kyphotic Cervical Alignment: Finite Element Analysis

Nishida¹,

Mumtaz²,

Tripathi³

et al. 2022

Preprint

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Background: Cervical laminoplasty is a useful for treatment of cervical myelopathy. However, this procedure has limitations for kyphotic cervical alignments. We used the finite element (FE) analysis and investigated the biomechanical changes in an intact and laminoplasty models with lordosis, straight, and kyphosis cervical alignments. Methods: A three-dimensional FE model of the cervical spine (C2-C7) with ligaments was created from computed tomography. The model was modified with the following cobb angles and the C3-C6 laminoplasty was conducted; a) laminoplasty-lordotic model (LM-L; C2-C7 angle: -10°), b) laminoplasty-straight model (LM-S; C2-C7 angle: 0°), and c) laminoplasty-kyphotic model (LM-K; C2-C7 angle: 10°). A pure moment with a compressive follower load of 100N to represent the weight of the head/cranium and cervical muscle stabilization was applied to these models. The range of motion (ROM), annular stress, nucleus stress and facet forces were analyzed. Results: ROM of LM-K increased when compared to the other models except for flexion. The LM-K had the highest mobility with 49% increase in ROM observed under extension, compared to the intact model. In all motion except for flexion, LM-L models’ ROM decreased by more than 10%, and LM-S and LM-K models’ ROM increased by more than 10% at C2-C7 compared to the intact model. The annular stresses and nucleus stresses in LM-K were higher compared to the other models. The maximum increase in annular stresses was about 194% in LM-K compared to the intact model, observed at the C3-C4 segment. The facet contact forces were lowest in the LM-K, compared to the other models.Conclusions: Patients with a cervical kyphosis alignment are at a disadvantage of increased kyphosis compared to cases with lordosis or straight alignment and should be treated with caution.

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Sagittal balance of the cervical spine: a systematic review and meta-analysis

Cited by 21 publications

References 121 publications

Does Improvement towards a Normal Cervical Sagittal Configuration Aid in the Management of Lumbosacral Radiculopathy: A Randomized Controlled Trial

Does Improvement towards a Normal Cervical Sagittal Configuration Aid in the Management of Lumbosacral Radiculopathy: A Randomized Controlled Trial

Is the Zero-P Spacer Suitable for 3-Level Anterior Cervical Discectomy and Fusion Surgery in Terms of Sagittal Alignment Reconstruction: A Comparison Study with Traditional Plate and Cage System

Comparison of Laminoplasty on Lordotic, Straight and Kyphotic Cervical Alignments Suggest Poor Outcomes for Kyphotic Cervical Alignment: Finite Element Analysis

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