Use of C7 Slope as a Surrogate Marker for T1 Slope: A Radiographic Study in Patients with and without Cervical Deformity

Chugh, Arunit J S; Patel, Monaliben; Gerges, Christina; Sunshine, Kerrin; Wilson, Betsy; Kasliwal, Manish K.

doi:10.1016/j.wneu.2020.07.219

Cited by 3 publications

(5 citation statements)

References 13 publications

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“…Considering the closeness of C7 and T1, we tried to evaluate whether the C7 slope of IS patients can be used as a substitute for the T1 slope. Although some literature does indicate that when the T1 slope cannot be displayed, the C7 slope can be used as a surrogate marker, but these studies did not involve patients with spinal deformity, 8,9,16 and it is still uncertain in the subgroup of patients with spinal deformity.…”

Section: Discussionmentioning

confidence: 99%

“…Although standing cervical lateral radiographs can be used to measure the slope of T1, anatomical interference from the shoulder and thoracic stem can hinder the visibility of the upper T1 endplate, especially in obese patients. Many studies have reported this phenomenon in the past 9,16. Chugh et al16 retrospectively analyzed 129 patients, of which 93% of patients had C7 slope visible on radiographs film, while the visible rate of T1 slope was only 68%.…”

Section: Discussionmentioning

confidence: 99%

“…Many studies have reported this phenomenon in the past 9,16. Chugh et al16 retrospectively analyzed 129 patients, of which 93% of patients had C7 slope visible on radiographs film, while the visible rate of T1 slope was only 68%. Ye et al9 also reported the same.…”

Section: Discussionmentioning

confidence: 99%

“…In order to solve these limitations, some authors suggest that when the upper endplate of T1 cannot be fully displayed on the radiographs film, it is feasible to replace the slope of T1 with the slope of C7, 8,[12][13][14][15] because the slope of C7 is highly correlated with the slope of T1. 8,9,16 In the preoperative imaging evaluation of IS patients, in addition to the influence of anatomical position and obesity, the T1 slope is not well displayed because of the imbalance of the spine sagittal plane and the existence of spinal deformities. At the same time, in the postoperative imaging evaluation, the visibility of the T1 slope will be more disturbed because of the presence of the upper thoracic spine implant.…”

mentioning

confidence: 99%

“…Although the T1 slope can be easily measured by computed tomography (CT) and magnetic resonance imaging, these are all supine scans and provide little information about the dynamic changes that occur when the patient is upright. In order to solve these limitations, some authors suggest that when the upper endplate of T1 cannot be fully displayed on the radiographs film, it is feasible to replace the slope of T1 with the slope of C7,8,12–15 because the slope of C7 is highly correlated with the slope of T1 8,9,16…”

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confidence: 99%

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Can C7 Slope Substitute the T1 Slope in Idiopathic Scoliosis Patients? A Radiographic Study

Fan

Wang

Cai

et al. 2021

Journal of Pediatric Orthopaedics

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Background: The aim of this study was to investigate whether C7 slope can be used as a substitute for T1 slope in idiopathic scoliosis. Methods: From January 2014 to October 2019, 101 patients who received posterior spinal internal fixation and fusion in our hospital were retrospectively analyzed. After analyzing the visibility of vertebral endplates, 46 cases of C7/T1 vertebral endplates were visible, including 14 males and 32 females, aged 9 to 18 years (mean 14.6 ± 2.0 y). The upper C7 slope, lower C7 slope, T1 slope, cervical lordosis and C2 to 7 sagittal vertebral axis were measured before and after operation and at the last follow-up. Pearson correlation coefficient was used to evaluate the correlation strength between upper C7 slope and T1 slope, and lower C7 slope and T1 slope. Through simple linear regression analysis, linear regression equations were generated from the upper and lower C7 slopes to predict T1 slope. Results: According to the 2 researchers' judgment, the visibility rate of the upper C7 endplate was 93.1% before operation, 93.1% after operation, and 91.1% at the last follow-up. The lower C7 endplate's visible rate was 72.3% before operation, 70.3% after operation and 68.3% at the last follow-up. The visible rate of T1 upper endplate was 52.5% before operation, 48.5% after operation and 50.5% at last follow-up. Linear regression analysis showed that the upper C7 slope and T1 slope in idiopathic scoliosis patients, regardless of preoperative (r = 0.908, P < 0.01), postoperative (r = 0.0.886, P < 0.01), follow-up (r = 0.899, P < 0.01), or overall (r = 0.895, P < 0.01), both have a close correlation; the lower C7 slope and the T1 slope are the same before surgery (r = 0.882, P < 0.01), after surgery (r = 0.940, P < 0.01), follow-up (r = 0.952, P < 0.01), or overall (r = 0.929, P < 0.01) all have statistical significance. Conclusion: When the upper endplate of T1 is not visible on standard radiographs, the upper or lower C7 slope can be used as a reliable alternative measurement parameter for sagittal balance assessment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Can C7 Slope Substitute the T1 Slope in Idiopathic Scoliosis Patients? A Radiographic Study

Fan

Wang

Cai

et al. 2021

Journal of Pediatric Orthopaedics

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Do key measurement parameters derived from specific cervical vertebral segments differ between lordotic and non-lordotic cervical spine alignments? A study of asymptomatic young adults

Daffin,

Stuelcken

2024

Journal of Bodywork and Movement Therapies

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The ratio of cervical lordosis to C7 slope represents the reciprocal change between cervical sagittal alignment and global spinal alignment

Wang

et al. 2023

J Orthop Surg Res

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Purpose This retrospective cross-sectional study investigated variations in the ratio of cervical lordosis to C7 slope (CL/C7S) at different stages of global sagittal balance to better understand how global sagittal alignment affects cervical alignment. Methods A total of 255 patients with the degenerative lumbar disease were retrospectively studied within a single medical center. Whole spine radiographs were used to evaluate sagittal parameters, mainly including occiput-C2 lordosis (OC2), cervical lordosis (CL), C7 slope (C7S), the ratio of cervical lordosis to C7 slope (CL/C7S), cervical sagittal vertical axis (CSVA), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), PI minus LL mismatch (PI–LL), and sagittal vertical axis (SVA). Patients were divided into the balance group (SVA < 50 mm, PI–LL ≤ 10°), hidden imbalance group (SVA < 50 mm, PI–LL > 10°), and imbalance group (SVA > 50 mm). Results Significant correlations were found between CL/C7S and OC2 (r = − 0.334), CSVA (r = − 0.504), PI–LL (r = 0.189), and SVA (r = 0.309). Multivariable linear regression analysis indicated that patients in the hidden imbalance group had lower CL/C7S than those in the balance group (B = − 0.234, P < 0.001), whereas the value of CL/C7S in patients with imbalanced sagittal alignment was higher than those with balanced alignment (B = 0.164, P = 0.011). The mean value of CL/C7S was 0.71, 0.51, and 0.97 in the balance, hidden imbalance, and imbalance groups, respectively. The global spine tended to tilt forward as the LL decreased, while TK, PT, PI–LL, and SVA increased (all, P < 0.001) from the balance stage to the imbalance stage. Conclusions CL/C7S tended to be lower when the thoracic extension increased to maintain global sagittal balance at the hidden imbalance stage. Inversely, CL/C7S increased significantly when the global spine showed severe anterior malalignment.

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Use of C7 Slope as a Surrogate Marker for T1 Slope: A Radiographic Study in Patients with and without Cervical Deformity

Cited by 3 publications

References 13 publications

Can C7 Slope Substitute the T1 Slope in Idiopathic Scoliosis Patients? A Radiographic Study

Can C7 Slope Substitute the T1 Slope in Idiopathic Scoliosis Patients? A Radiographic Study

Do key measurement parameters derived from specific cervical vertebral segments differ between lordotic and non-lordotic cervical spine alignments? A study of asymptomatic young adults

The ratio of cervical lordosis to C7 slope represents the reciprocal change between cervical sagittal alignment and global spinal alignment

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