Factors determining cervical spine sagittal balance in asymptomatic adults

Correlation with spinopelvic balance and thoracic inlet alignment

Sang Hun Lee, Eun Seok Son, Eun Min Seo, Kyung Soo Suk, Ki Tack Kim

Research output: Contribution to journalArticle

Abstract

Background context Based on the previous studies, cervical lordosis (CL) is a parameter influenced by thoracic kyphosis (TK); however, the correlations still remain unclear. Few studies have analyzed the correlations between the cervical spine lordosis and global spinopelvic balance. To date, there has been no study focused on the factors determining cervical spine sagittal balance. Patient sample Seventy-seven asymptomatic volunteers without the history of symptoms related to whole spine. Outcome measures Statistical significance of correlations of radiographic parameters on cervical spine and whole-spine standing lateral radiograph. Purpose To analyze the factors determining cervical spine sagittal balance, including global spinopelvic balance and thoracic inlet (TI) alignment in asymptomatic adults. Study design A prospective radiographic study. Methods Cervical and whole-spine standing lateral radiographs were taken to analyze the following parameters: spinopelvic parameters pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL), and TK; TI parameters thoracic inlet angle (TIA) and T1 slope; and cervical spine parameters C0-C2, C2-C7, and C0-C7 angles and cervical tilting. Statistical analysis was performed using the Pearson correlation coefficients and multiple regression analysis. Results All the parameters showed a normal distribution. There was a significant sequential linkage between PI and SS (r=0.653), SS and LL (r=0.807), LL and TK (r=-0.516), and TK and C0-C7 angle (r=-0.322). There was a significant relationship between TK and T1 slope (r=0.351) but no significant relationship between TK and TIA. There were significant sequential relationships between TIA and T1 slope (r=0.694), T1 slope and C2-C7 angle (r=-0.624), and C2-C7 and C0-C2 angles (r=-0.547). T1 slope was the only parameter that demonstrated a significant correlation with both SP and TI parameters. A linear regression model showed that T1 slope had a stronger relationship with TIA (r=0.694) than TK (r=0.351). Conclusions T1 slope was a key factor determining cervical spine sagittal balance. Both spinopelvic balance and TI alignment have a significant influence on cervical spine sagittal balance via T1 slope, but TIA had a stronger effect than TK. An individual with large T1 slope required large CL to preserve physiologic sagittal balance of the cervical spine. The results of the present study could serve as baseline data for further studies on the cervical spine sagittal balance in various clinical conditions including the surgical reconstruction of lordosis.

Original languageEnglish (US)
Pages (from-to)705-712
Number of pages8
JournalSpine Journal
Volume15
Issue number4
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

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Spine
Thorax
Kyphosis
Lordosis
Linear Models
Normal Distribution
Incidence
Statistical Factor Analysis
Volunteers
History
Regression Analysis
Outcome Assessment (Health Care)
Prospective Studies

Keywords

  • Cervical spine sagittal balance
  • Spinopelvic balance
  • T1 slope
  • Thoracic inlet alignment

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Factors determining cervical spine sagittal balance in asymptomatic adults : Correlation with spinopelvic balance and thoracic inlet alignment. / Lee, Sang Hun; Son, Eun Seok; Seo, Eun Min; Suk, Kyung Soo; Kim, Ki Tack.

In: Spine Journal, Vol. 15, No. 4, 01.01.2015, p. 705-712.

Research output: Contribution to journalArticle

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keywords = "Cervical spine sagittal balance, Spinopelvic balance, T1 slope, Thoracic inlet alignment",
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T1 - Factors determining cervical spine sagittal balance in asymptomatic adults

T2 - Correlation with spinopelvic balance and thoracic inlet alignment

AU - Lee, Sang Hun

AU - Son, Eun Seok

AU - Seo, Eun Min

AU - Suk, Kyung Soo

AU - Kim, Ki Tack

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Background context Based on the previous studies, cervical lordosis (CL) is a parameter influenced by thoracic kyphosis (TK); however, the correlations still remain unclear. Few studies have analyzed the correlations between the cervical spine lordosis and global spinopelvic balance. To date, there has been no study focused on the factors determining cervical spine sagittal balance. Patient sample Seventy-seven asymptomatic volunteers without the history of symptoms related to whole spine. Outcome measures Statistical significance of correlations of radiographic parameters on cervical spine and whole-spine standing lateral radiograph. Purpose To analyze the factors determining cervical spine sagittal balance, including global spinopelvic balance and thoracic inlet (TI) alignment in asymptomatic adults. Study design A prospective radiographic study. Methods Cervical and whole-spine standing lateral radiographs were taken to analyze the following parameters: spinopelvic parameters pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL), and TK; TI parameters thoracic inlet angle (TIA) and T1 slope; and cervical spine parameters C0-C2, C2-C7, and C0-C7 angles and cervical tilting. Statistical analysis was performed using the Pearson correlation coefficients and multiple regression analysis. Results All the parameters showed a normal distribution. There was a significant sequential linkage between PI and SS (r=0.653), SS and LL (r=0.807), LL and TK (r=-0.516), and TK and C0-C7 angle (r=-0.322). There was a significant relationship between TK and T1 slope (r=0.351) but no significant relationship between TK and TIA. There were significant sequential relationships between TIA and T1 slope (r=0.694), T1 slope and C2-C7 angle (r=-0.624), and C2-C7 and C0-C2 angles (r=-0.547). T1 slope was the only parameter that demonstrated a significant correlation with both SP and TI parameters. A linear regression model showed that T1 slope had a stronger relationship with TIA (r=0.694) than TK (r=0.351). Conclusions T1 slope was a key factor determining cervical spine sagittal balance. Both spinopelvic balance and TI alignment have a significant influence on cervical spine sagittal balance via T1 slope, but TIA had a stronger effect than TK. An individual with large T1 slope required large CL to preserve physiologic sagittal balance of the cervical spine. The results of the present study could serve as baseline data for further studies on the cervical spine sagittal balance in various clinical conditions including the surgical reconstruction of lordosis.

AB - Background context Based on the previous studies, cervical lordosis (CL) is a parameter influenced by thoracic kyphosis (TK); however, the correlations still remain unclear. Few studies have analyzed the correlations between the cervical spine lordosis and global spinopelvic balance. To date, there has been no study focused on the factors determining cervical spine sagittal balance. Patient sample Seventy-seven asymptomatic volunteers without the history of symptoms related to whole spine. Outcome measures Statistical significance of correlations of radiographic parameters on cervical spine and whole-spine standing lateral radiograph. Purpose To analyze the factors determining cervical spine sagittal balance, including global spinopelvic balance and thoracic inlet (TI) alignment in asymptomatic adults. Study design A prospective radiographic study. Methods Cervical and whole-spine standing lateral radiographs were taken to analyze the following parameters: spinopelvic parameters pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL), and TK; TI parameters thoracic inlet angle (TIA) and T1 slope; and cervical spine parameters C0-C2, C2-C7, and C0-C7 angles and cervical tilting. Statistical analysis was performed using the Pearson correlation coefficients and multiple regression analysis. Results All the parameters showed a normal distribution. There was a significant sequential linkage between PI and SS (r=0.653), SS and LL (r=0.807), LL and TK (r=-0.516), and TK and C0-C7 angle (r=-0.322). There was a significant relationship between TK and T1 slope (r=0.351) but no significant relationship between TK and TIA. There were significant sequential relationships between TIA and T1 slope (r=0.694), T1 slope and C2-C7 angle (r=-0.624), and C2-C7 and C0-C2 angles (r=-0.547). T1 slope was the only parameter that demonstrated a significant correlation with both SP and TI parameters. A linear regression model showed that T1 slope had a stronger relationship with TIA (r=0.694) than TK (r=0.351). Conclusions T1 slope was a key factor determining cervical spine sagittal balance. Both spinopelvic balance and TI alignment have a significant influence on cervical spine sagittal balance via T1 slope, but TIA had a stronger effect than TK. An individual with large T1 slope required large CL to preserve physiologic sagittal balance of the cervical spine. The results of the present study could serve as baseline data for further studies on the cervical spine sagittal balance in various clinical conditions including the surgical reconstruction of lordosis.

KW - Cervical spine sagittal balance

KW - Spinopelvic balance

KW - T1 slope

KW - Thoracic inlet alignment

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