Difference in Spinal Sagittal Alignment and Health-Related Quality of Life between Males and Females with Cervical Deformity

Incidence of Cervical Kyphosis and Factors Associated with Improvement in Postoperative Cervical Spinal Alignment in Idiopathic Scoliosis with Major Thoracolumbar/Lumbar and Thoracic Curves

Background: This study aimed to compare the incidence and severity of cervical kyphosis before and after surgery between patients with adolescent idiopathic scoliosis (AIS) with major thoracolumbar/lumbar curves (Lenke type 5C group) and those with major thoracic curves (Lenke type 1A group). Further, factors associated with cervical spinal alignment changes after surgery in the two groups were examined. Methods: This study included consecutive patients with AIS who underwent posterior spinal fusion for Lenke type 1A and 5C curves and who were followed up for at least 1 year. To measure changes in sagittal alignment, all patients underwent radiography before, immediately after, and at 1 year after surgery. The correlation coefficients change the value of the C2-C7 angle before and after surgery (ΔC2-ΔC7) and other spinopelvic parameters were examined. Results: In total, 19 of 30 patients in the Lenke type 1A group and 21 of 36 in the Lenke type 5C group presented with cervical kyphosis preoperatively. Hence, the incidence of cervical kyphosis did not significantly differ between the two groups. Further, the two groups had significantly higher thoracic kyphosis (TK) and greater C2-C7 angles postoperatively. The TK of the Lenke type 5C group further increased at 1 year postoperatively. The Lenke 1A type group presented with a significant re-decrease in the C2-C7 angle at 1 year postoperatively. However, the C2-C7 angle of the Lenke type 5C group did not change. The ΔTK was closely associated with the ΔC2-ΔC7 in the Lenke type 1A group, but not in the Lenke type 5C group. Conclusions: In thoracic AIS, postoperative cervical alignment should achieve an adequate TK and promote correction of the coronal plane curve. Moreover, selective corrective surgery can improve postoperative cervical alignment in lumbar AIS.

Comparison of Laminectomy with Fusion and Laminoplasty Treating Multilevel Cervical Spondylotic Myelopathy: A Single-Center Retrospective Study

OBJECTIVE

Comparing laminectomy with fusion (LF) and laminoplasty (LP) for treating multilevel cervical spondylotic myelopathy (MCSM) and comparative analysis of neck pain and sagittal cervical parameters.

METHODS

This single-center study retrospectively analyzed MCSM patients treated with LF or LP in our department between June 2018 and January 2023, with at least a 12-month follow-up. T-tests were used to identify operation time, hemoglobin, hospital stay, modified Japanese Orthopaedic Association (mJOA) score, C2-C7 Cobb angle, C2-C7 sagittal vertical axis, T1 slope, cervical range of motion (cROM), and C4/5 anterior and posterior spinal canal diameter (A-P diameter) and area. Nonparametric tests were used to identify visual analog scale (VAS) score (assessing neck pain). Pearson correlation analyses were used to identify the neck pain.

RESULTS

Of all 67 patients (LF: 24, LP: 43), both groups' mJOA scores significantly improved (P < 0.001). The VAS scores had both significantly decreased, with the LF group exhibiting a more marked reduction (LF: P < 0.001, LP: P = 0.037). Both groups' C4/5 A-P diameters and areas increased significantly (P < 0.001). The cROM had both significantly decreased, with the LF group exhibiting a greater reduction. At the last follow-up, the LF group's T1 slope and C2-C7 Cobb angle considerably increased, and pain VAS scores substantially correlated with the C2-C7 Cobb angle (R = -0.451, P < 0.001).

CONCLUSIONS

LF and LP were efficacious for MCSM. LF relieved neck pain better but caused greater reduction in cervical mobility. Cervical lordosis improvement was significantly correlated with neck pain alleviation.

Adult cervical spine deformity: a state-of-the-art review

Adult cervical deformity is a structural malalignment of the cervical spine that may present with variety of significant symptomatology for patients. There are clear and substantial negative impacts of cervical spine deformity, including the increased burden of pain, limited mobility and functionality, and interference with patients' ability to work and perform everyday tasks. Primary cervical deformities develop as the result of a multitude of different etiologies, changing the normal mechanics and structure of the cervical region. In particular, degeneration of the cervical spine, inflammatory arthritides and neuromuscular changes are significant players in the development of disease. Additionally, cervical deformities, sometimes iatrogenically, may present secondary to malalignment or correction of the thoracic, lumbar or sacropelvic spine. Previously, classification systems were developed to help quantify disease burden and influence management of thoracic and lumbar spine deformities. Following up on these works and based on the relationship between the cervical and distal spine, Ames-ISSG developed a framework for a standardized tool for characterizing and quantifying cervical spine deformities. When surgical intervention is required to correct a cervical deformity, there are advantages and disadvantages to both anterior and posterior approaches. A stepwise approach may minimize the drawbacks of either an anterior or posterior approach alone, and patients should have a surgical plan tailored specifically to their cervical deformity based upon symptomatic and radiographic indications. This state-of-the-art review is based upon a comprehensive overview of literature seeking to highlight the normal cervical spine, etiologies of cervical deformity, current classification systems, and key surgical techniques.

Effects of Sacral Slope Changes on the Intervertebral Disc and Hip Joint: A Finite Element Analysis

OBJECTIVE

Spinopelvic parameters are vital components that must be considered when treating patients with spinal disease. Several finite element (FE) studies have explored spinopelvic parameters such as sacral slope (SS) and the impact on the lumbar spine, although no study has examined the effect on the hip and sacroiliac joint (SIJ) on varying SS angles. Therefore, it is necessary to have a biomechanical understanding of the impact on the spinopelvic complex.

METHODS

An FE lumbar, pelvis, and femur model was created from computed tomography scans of a 55-year-old female patient with no abnormalities. Three models were created: a normal model (SS = 26°), a model with high SS (SS = 30°), and a model with low SS (SS = 20°). These models underwent loading for flexion, extension, lateral bending, and axial rotation. Range of motion (ROM), intradiscal pressures, hip joint, and SIJ contact stresses were analyzed.

RESULTS

The high SS model (SS = 30°) indicated the highest ROM in the L5-S1 (slip angle) level and the highest intradiscal pressures. The highest average hip and SIJ contact stresses were present in this model, although the low SS model (SS = 20°) in extension had the largest stresses for the hip and SIJ.

CONCLUSIONS

The results provide evidence that patients with higher SS may be more prone to increased ROM at the slip angle (L5-S1). In addition, patients with higher SS were shown to have higher contact stresses on the hip joint and SIJ, potentially leading to SIJ dysfunction. Clinically, correcting lumbar lordosis including SS is important; however, a high SS may have a negative impact on the intervertebral disc, SIJ, and hip joint.

Relationship between C2 slope with sagittal parameters and clinical function of degenerative cervical kyphosis

PURPOSE

To explore the relationship between C2 slope with sagittal parameters and clinical function of degenerative cervical kyphosis (DCK).

METHODS

A retrospective analysis of 127 patients with degenerative cervical spondylosis treated in our spinal deformity center from January 2019 to June 2022. Patients were categorized into two groups and compared based on C2-7 angle (C2-7 ≥ 5° as kyphosis group, C2-7 < 5° as lordosis group). Pearson correlation or Spearman correlation was used to analyze the relationship between C2S and conventional radiological parameters and health -related quality-of-life (HRQOL) outcomes as measured by the EuroQol 5 dimension questionnaire (EQ5D), NRS, and the neck disability index (NDI). The cutoff value of C2S was determined by a receiver operating characteristic (ROC) curve.

RESULTS

There were 127 patients who met inclusion criteria (79 men and 48 women). Average 56.00 ± 10.27 years old (range 31-81 years old). C2S of kyphosis group is higher than non-kyphosis group. Aggravating cervical kyphosis increases cSVA positively. For all patients, C2S demonstrated a significant correlation with the O-C2 angle, C2-7 angle, cSVA, and TS-CL (p < 0.05). NRS, NDI and EQ5D-VAS scores revealed a significant correlation with C2S and cSVA (p < 0.01). For the subgroup of patients presenting with DCK, ROC curves demonstrated the cutoff values of C2S as 26.3°, and 30.5°, according to a cSVA of 40 mm, and severe disability expressed by NDI, respectively.

CONCLUSION

On the basis of retaining the consistency of cranio-cervical and cervico-thoracic structure, C2S can better analyze the sagittal alignment of DCK patients than TS-CL and has good practicability in clinical application and HRQOL evaluation.

Risk Factors for Cervical Deformity After Posterior Cervical Decompression Surgery: A Multicenter Study

STUDY DESIGN

Retrospective multicenter study.

OBJECTIVE

Posterior decompression surgery for cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL) is a common surgery; however, it can cause postoperative cervical deformity (CD). The purpose of this study was to investigate the risk factors for CD.

METHODS

The participants were 193 patients underwent laminoplasty or laminectomy for CSM or OPLL. CD was defined as a C2-7 sagittal vertical axis (SVA) ≥ 40 mm or a cervical lordosis angle (CL) ≤ -10°. The participants were divided into 2 groups: NCD (without CD before surgery), CD (with CD before surgery). NCD group was divided based on the presence of CD 1 year after surgery as follows: postoperative CD (PCD) and no PCD (NPCD).

RESULTS

There were 153 patients (NCD), 40 (CD), 126 (NPCD), and 27 (PCD). There was significant difference in the number of decompressed lamina (NPCD: PCD = 4.1:4.5), the presence of C2 decompression (2: 11%), and C5 palsy (0: 11%). The risk factors for onset of CD, PCD, and CL ≤ -10° as assessed by multiple logistic regression analysis were preoperative C2-7 SVA ≥ 30 mm (odds ratio [OR]: 19.0), decompression of C2 or C7 lamina (OR 3.1), and preoperative CL ≤ 2° (OR 42.0), respectively.

CONCLUSIONS

To prevent postoperative CD, it is important to avoid decompression of the C2 or C7 lamina. Moreover, in case with C2-7 SVA ≥ 30 mm or CL ≤ 2° before surgery, it is important to explain the risks and consider adding fusion surgery.

Reciprocal Changes in the Whole-Body Following Realignment Surgery in Adult Spinal Deformity

The idea of the global balance of spine stems from Jean Dubousset, who first introduced the concept of cone of economy. Through the compensatory mechanisms, the human body maintains an upright posture and horizontal gaze in the setting of the spinal malalignment. Compensation takes place not only in the mobile spine segments, but also in the pelvis and lower extremities. Patients with a malalignment exhibit compensatory changes in the cervical hyper-lordosis, posterior pelvic shift, knee/ankle flexion, hip extension, and the pelvic retroversion. The advent of whole-body stereo radiography has yielded an improved understanding of global changes among the patients. Deformity-induced compensatory changes in the sagittal alignment could be resolved reciprocally after the surgical correction of the malalignment. Thoracolumbar realignment surgery restores the pathologic compensatory changes in the unfused spinal segments, pelvis, and the lower extremities. Similarly, reciprocal changes in the thoracolumbar spine may harmonize global sagittal alignment after the cervical reconstruction. This study reviews the compensatory mechanisms and reciprocal changes in global sagittal alignment caused by the surgical correction and highlights, the factors that should be considered while assessing a patient's compensatory status.

[Radiological features of degenerative cervical kyphosis and relationship between sagittal parameters]

OBJECTIVE

To investigate the radiological features of degenerative cervical kyphosis (DCK) and the relationship between cervical sagittal parameters.

METHODS

The quality of life scores and imaging data of 89 patients with DCK treated between February 2019 and February 2022 were retrospectively analysed. There were 47 males and 42 females, with an average age of 48.4 years (range, 25-81 years). Quality of life scores included visual analogue scale (VAS) score and neck disability index (NDI). The imaging data included C ₀-C ₂ angle, C ₂-C ₇ angle, C ₃-C ₇ inclination of zygapophyseal joints, C ₇ slope (C ₇S), cervical sagittal vertical axis (cSVA), kyphosis range, and kyphosis focal. The patients were grouped by gender, and the differences of the above parameters between the two groups were compared. Pearson correlation was used to analyze the relationship between age, quality of life scores, and cervical sagittal parameters, and the relationship between cervical sagittal parameters.

RESULTS

The preoperative VAS score was 0-9 (mean, 4.3); NDI was 16%-44% (mean, 30.0%). There was no significant difference in VAS score and NDI between male and female groups ( P>0.05). The kyphosis range of cervical spines was C _3-5 in 3 cases, C _3-6 in 41 cases, C _3-7 in 30 cases, C _4-6 in 4 cases, C _4-7 in 10 cases, C _5-7 in 1 case, and the kyphosis focal was mostly located between C ₄-C ₅ (78/89, 87.64%). The C ₃-C ₇ inclination of zygapophyseal joints were (60.25±5.56)°, (55.42±5.77)°, (53.03±6.33)°, (58.39±7.27)°, and (64.70±6.40)°, respectively. The C ₀-C ₂ angle, C ₂-C ₇ angle, C ₇S, and cSVA were (-23.81±6.74)°, (10.15±2.94)°, (15.31±4.59)°, and (2.37±1.19) mm, respectively. The C ₇S and cSVA of males were significantly larger than females ( P<0.05), with no significant difference in other parameters between male and female groups ( P>0.05). VAS score and NDI were negatively correlated with C ₀-C ₂ angle ( P<0.05), and positively correlated with C ₂-C ₇ angle and cSVA ( P<0.05); VAS score was negatively correlated with C ₇S ( P<0.05). Except VAS, NDI and all cervical sagittal parameters were affected by age. Age was positively correlated with NDI, C ₇S, and cSVA ( P<0.05), and negatively correlated with C ₀-C ₂ angle and C ₂-C ₇ angle ( P<0.05). The correlation analysis of cervical sagittal parameters showed that C ₀-C ₂ angle was negatively correlated with C ₂-C ₇ angle and cSVA ( P<0.05); C ₇S was negatively correlated with C ₂-C ₇ angle ( P<0.05) and positively correlated with cSVA ( P<0.05). There was no correlation among other parameters ( P>0.05).

CONCLUSION

The inclination of zygapophyseal joints of cervical spines of DCK patients is U-shaped in the kyphosis range, and the inclination at the kyphosis focal is the smallest. When cervical degenerative kyphosis occurs, in addition to the interaction of sagittal parameters, age, gender, neck pain, and dysfunction will also affect the cervical sagittal balance. Furthermore, cervical curvature and morphological changes are not purely local problems.

Cervical Spinal Alignment Change Accompanying Spondylosis Exposes Harmonization Failure with Total Spinal Balance: A Japanese Cohort Survey Randomly Sampled from a Basic Resident Registry

The relationship between spinal posture and quality of life has garnered considerable attention with the increase in older community-dwelling residents. However, details of this association remain insufficient. A recent Japanese population cohort epidemiological locomotion survey (the Obuse study) revealed that the C2–C7 cervical sagittal vertical axis (CSVA) began to increase in males from their 60s, but not in females. This study aimed to clarify the pathology of these cervical spondylotic changes. A total of 411 participants (202 male and 209 female) aged between 50 and 89 years were selected by random sampling from a cooperating town’s resident registry. All participants underwent lateral X-ray photography in a standing position for the measurement of several sagittal spinal alignment parameters, including CSVA, C2–C7 cervical lordosis (CL), T1 slope (T1S), and sagittal vertical axis (SVA). The presence of cervical spondylotic changes was also recorded. Associations of cervical sagittal spinal alignment with cervical spondylosis and between cervical and total sagittal spinal alignment were examined. The prevalence of cervical spondylosis was significantly higher in males (81%) than in females (70%) (p = 0.01). CL was significantly smaller in cervical spondylosis subjects when adjusted by age (3.4 degrees less; p = 0.01). T1S minus CL displayed a moderate positive correlation with CSVA in both males and females (r = 0.49 and 0.48, respectively, both p < 0.01). In males only, CSVA and CL showed weak positive correlations with SVA (r = 0.31 and 0.22, respectively, both p < 0.01) independently of age. Cervical spinal misalignment was more clearly associated with diminished SF-8^TM scores in females than in males. In community-dwelling elderly residents, cervical sagittal spinal alignment change accompanying cervical spondylosis manifested as hypofunction to compensate for whole-spine imbalance.

Analysis of individual differences in pelvic and spine alignment in seated posture and impact on the seatbelt kinematics using human body model

Analysis using human body models has been performed to reduce the impact of accidents; however, no analysis has shown a relationship between lumbar and pelvic/spine angle and seat belts in reducing human damage from accidents. Lumbar and pelvic/spine angles were measured in 75 individuals and the measurements were used to create three different angles for the Total Human Model for Safety model. In the present study, we focused on lumber lordosis (LL) and pelvic angle (PA). A normal distribution and histogram were used for analysis of PA (01, 10, and 50). The Total Human Model for Safety, including LL and PA, was corrected using finite element software. Simulations were conducted under the conditions of the Japan New Car Assessment Programme (JNCAP) 56 kph full lap frontal impact. Using the results of the FEM, the amount of lap-belt cranial sliding-up, anterior movement of the pelvis, posterior tilt of the pelvis, head injury criterion (HIC), second cervical vertebrae (C2) compressive load, C2 moment, chest deflectiou (upper, middle, and lower), left and right femur load, and shoulder belt force were measured. The lap-belt cranial sliding-up was 1.91 and 2.37 for PA10 and PA01, respectively, compared to PA50; the anterior movement of the pelvis was 1.08 and 1.12 for PA10 and PA01, respectively; and the posterior tilt of the pelvis was 1.1 and 1.18 for PA10 and PA01, respectively. HIC was 1.13 for PA10 and 1.58 for PA01; there was no difference in C2 compressive load by PA, but C2 moment increased to 1.59 for PA10 and 2.72 for PA01. It was found that as LL increases and the PA decreases, the seat belt becomes likely to catch the iliac bone, making it harder to cause injury. This study could help to reconsider the safe seat and seatbelt position in the future.

Association of Spinal Alignment Correction With Patient-Reported Outcomes in Adult Cervical Deformity: Review of the Literature

Objective

Adult cervical deformity (ACD) is a debilitating spinal condition that causes significant pain, neurologic dysfunction, and functional impairment. Surgery is often performed to correct cervical alignment, but the optimal amount of correction required to improve patient-reported outcomes (PROs) are not yet well-defined.

Methods

A review of the literature was performed and Fisher's z-transformation (Zr) was used to pool the correlation coefficients between alignment parameters and PROs. The strength of correlation was defined according to the following: poor (0 < r ≤ 0.3), fair (0.3 < r ≤ 0.5), moderate (0.5 < r ≤ 0.8), and strong (0.8 < r ≤ 1).

Results

Increased C2-C7 SVA was fairly associated with increased Neck Disability Index (NDI) (pooled Zr = 0.31; 95% CI, -0.03, 0.58). Changes in TS-CL poorly correlated with NDI (pooled Zr = -0.04; 95% CI, -0.23-0.30). Increased C7-S1 was poorly associated with worse EQ-5D (pooled Zr = -0.22; 95% CI, -0.36, -0.06). Correction of horizontal gaze (CBVA) did not correlate with legacy metrics. mJOA correlated with C2-slope, C7-S1, and C2-S1.

Conclusion

Spinal alignment parameters variably correlated with improved HRQoL and myelopathy after corrective surgery for ACD. Further studies evaluating legacy PROs, PROMIS, and ACD specific instruments are needed for further validation.

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

PURPOSE

The purpose of this systematic review and meta-analysis was to compare the cervical sagittal parameters between patients with cervical spine disorder and asymptomatic controls.

METHODS

Two independent authors systematically searched online databases including Pubmed, Scopus, Cochrane library, and Web of Science up to June 2020. Cervical sagittal balance parameters, such as T1 slope, cervical SVA (cSVA), and spine cranial angle (SCA), were compared between the cervical spine in healthy, symptomatic, and pre-operative participants. Where possible, we pooled data using random-effects meta-analysis, by CMA software. Heterogeneity and publication bias were assessed using the I-squared statistic and funnel plots, respectively.

RESULTS

A total of 102 studies, comprising 13,802 cases (52.7% female), were included in this meta-analysis. We used the Newcastle-Ottawa Scale (NOS) to evaluate the quality of studies included in this review. Funnel plot and Begg's test did not indicate obvious publication bias. The pooled analysis reveals that the mean (SD) values were: T1 slope (degree), 24.5 (0.98), 25.7 (0.99), 25.4 (0.34); cSVA (mm), 18.7 (1.76), 22.7 (0.66), 22.4 (0.68) for healthy population, symptomatic, and pre-operative assessment, respectively. The mean value of the SCA (degree) was 79.5 (3.55) and 75.6 (10.3) for healthy and symptomatic groups, respectively. Statistical differences were observed between the groups (all P values < 0.001).

CONCLUSION

The findings showed that the T1 slope and the cSVA were significantly lower among patients with cervical spine disorder compared to controls and higher for the SCA. Further well-conducted studies are needed to complement our findings.

The significance of cervical sagittal alignment for nonrecovery after whiplash injury

BACKGROUND CONTEXT

Whiplash-associated disorder is a common cause of chronic neck pain. Several radiological cervical angular variables are suggested to have constitutional characteristics, that is, them being minimally influenced by body positioning. However, the association between these variables and pain conditions remains poorly understood. To our knowledge, no previous studies have investigated the association between constitutional angular variables and the outcome after whiplash trauma.

PURPOSE

Our objectives were (1) to study the inter-rater agreement of sagittal radiologic variables between 2 raters and (2) to investigate any association between these variables and self-perceived nonrecovery after whiplash injury.

STUDY DESIGN

Prospective cohort study.

PATIENT SAMPLE

Forty-six patients aged 16 to 70 years, attending an emergency department after a motor vehicle accident resulting in neck pain were recruited.

OUTCOME MEASURES

Self-perceived nonrecovery (yes/no) was the primary outcome measure. The secondary outcome measure was pain level on a numeric rating scale.

METHODS

The participants underwent computed tomography scans in a supine position. Sagittal alignment variables (T1 slope, neck tilt, thoracic inlet angle [TIA], and C2-C7 angle) on the computed tomography scans were measured by 2 independent raters. Inter-rater agreement was tested with a paired sample t test and Bland-Altman plots for each variable. The patients were followed up after 6 months.

RESULTS

No systematic differences for the assessed variables were found between the 2 raters. The overall nonrecovery rate was 28%. For the group with low neck tilt, the nonrecovery rate was 50% (95% CI: 36%-78%) and for the group with high neck tilt, 8% (95% CI: 3%-25%). The nonrecovery rate for the group low TIA was 50% (95% CI 29%-72%) and for those with high TIA 14% (95% CI 4%-26%). The associations remained significant after adjustments for possible confounders. The inter-rater analysis shows satisfactory agreement without proportional bias.

CONCLUSIONS

This study indicates the existence of an association between the constitutional sagittal alignment of the cervical spine and the outcome after whiplash injuries.

Changes in the global spine alignment in the sitting position in an automobile

BACKGROUND CONTEXT

Studies of the changes in spine alignment in the sitting position have been limited to specific spine segments. Because there have been few studies of global spinopelvic alignment in the sitting position, it is important to assess the changes associated with this position for such settings as developing future design of seats and achieving appropriate restoration of spine alignment.

PURPOSE

This study aimed to measure changes in global spine alignment when people are sitting in car seats and to analyze the characteristics of those changes.

STUDY DESIGN

This was a prospective, collaborative study of the radiological evaluation of changes in global spine alignment.

PATIENT SAMPLE

The study included 113 asymptomatic adult participants (56 men and 57 women) without a history of spine disease or lower limb surgery, and with no current lower back or leg pain.

OUTCOME MEASURES

Radiographic findings were assessed by measurement of various angles: cervical lordosis (CL), thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), C7 sagittal vertical axis (C7-SVA), T1 spinopelvic inclination (T1SPI), and T1 pelvic angle (TPA).

METHODS

Radiographs were obtained in the standing and sitting positions. The objective variables analyzed statistically were spine alignments (CL, TK, TLK, LL, C7-SVA, T1SPI, TPA, SS, PT, and PI) measured in the standing position, body alignments (CL, TK, TLK, LL, C7-SVA, T1SPI, TPA, SS, and PT) measured in the sitting position, and stand-to-sit changes (∆CL, ∆TK, ∆TLK, ∆LL, ∆C7-SVA, ∆T1SPI, ∆TPA, ∆SS, and ∆PT). Explanatory variables were sex, age, body height, and body mass index.

RESULTS

Changing posture from standing to sitting decreased CL by an average of 5.3°, slightly decreased TK by an average of 1.3°, increased TLK by an average of 6.8°, decreased LL by an average of 35°, decreased SS by an average of 49.2°, increased PT by an average of 49.2°, shifted C7-SVA backward by an average of 106.7 mm, decreased T1SPI by an average of 18.8°, and increased TPA by an average of 21.1°. Statistical analysis revealed that ΔLL was significantly decreased in elderly participants. After the stand-to-sit change, ΔTLK and ∆TPA were significantly increased in taller participants and ΔT1SPI was significantly decreased in taller participants.

CONCLUSIONS

Among other changes, most notably LL is decreased and the pelvic tilt is increased when a person is sitting in a car seat. However, these changes in spine alignment differ with age and height. These findings may be useful for the development of future design of seats and for achieving appropriate surgical restoration of spine alignment.

Spinal Sagittal Alignment, Hospital Anxiety and Depression Scale Scores, and Patient-Reported Outcome among People with Sporting Activity

STUDY DESIGN

Retrospective cohort study.

PURPOSE

This study aimed to investigate how participation in sporting activity affects patient-reported outcome (PRO), including Neck Disability Index (NDI), in males and females.

OVERVIEW OF LITERATURE

Previously, our study reported that factors with a negative influence on the NDI in females were a lack of sporting activities. However, it was still unclear why it affected poor scores of NDI.

METHODS

The subjects were 473 volunteers. They were divided into two groups (activity and non-activity) according to participation or non-participation in sporting activities using a self-filled questionnaire. The evaluation items were height, weight, grip strength, bone density, Hospital Anxiety and Depression Scale (HADS) score, standing radiographic parameters, PRO (evaluated by EuroQol-5 dimension [EQ-5D], Oswestry Disability Index [ODI]), and NDI.

RESULTS

There were 101 males in the non-activity group and 69 in the activity group and 178 females in the non-activity group and 125 in the activity group. For the males, the evaluation items with significant influence were cervical lordosis (non-activity group:activity group, 17°:22°) and T1 slope minus cervical lordosis (10°:6°, p <0.05). For the females, the evaluation items with significant influence were sagittal vertical axis (28:14 mm), HADS (10.4:8.4), EQ-5D (0.79:0.86), ODI (17:12), and NDI (12:9, p <0.01). HADS and PRO in the females were significantly correlated with the EQ-5D (-0.40), ODI (0.43), and NDI (0.55).

CONCLUSIONS

Males who participated in sporting activities had better cervical spine alignment but no effect on PRO. Females with sporting activities had better spinal global alignment and less mental stress. It is suggested that sporting activity in females might be associated with PRO because HADS highly correlates with PRO.

Cervical kyphosis in asymptomatic populations: incidence, risk factors, and its relationship with health-related quality of life

Background

Cervical kyphosis has been pointed out in asymptomatic populations. The purposes of this study were (1) to investigate the incidence of cervical kyphosis in asymptomatic populations, (2) to identify risk factors related to cervical kyphosis, and (3) to assess the relationship between cervical kyphosis and health-related quality of life (HRQOL).

Methods

A cohort of 235 asymptomatic volunteers’ records was retrospectively analyzed. Radiographic parameters of the coronal and sagittal planes were measured in the full-length spine x-ray. All patients were classified into two groups based on the cervical lordosis angle: cervical lordosis (CL) and cervical kyphosis (CK). HRQOL was evaluated by EQ-5D and SF-36 (PCS and MCS) questionnaires.

Results

CK was observed in 90 of 235 (38.3%) participants. There was a significant difference with regard to age between volunteers with CK and CL (32.23 ± 8.12 vs. 42.12 ± 6.14, p < 0.05). Several parameters had a significant relationship with CK, including TK, T1 slope, TIA, SVA, and CT. Logistic regression analysis identified age, TK, T1 slope, and SVA as independent risk factors of CK. In addition, there was a negative correlation between CK and the parameters of HRQOL (EQ-5D, − 0.63; PCS, − 0.68; MCS, − 0.59).

Conclusions

The incidence of CK in normal populations is 38.3%. Some spinal parameters are related to CK. CK is associated with the HRQOL.

The Relationship Between Neuropathic Pain and Spinal Alignment: Independent Risk Factors for Low Quality of Life in Middle-Aged and Elderly People

STUDY DESIGN

Prospective research in middle-aged and elderly people.

OBJECTIVE

To investigate low back pain (LBP) and neuropathic pain (NeP); spinal alignment and range of motion (ROM); spinal degenerative changes in plain radiography; osteoporosis; muscle strength; and physical ability as possible risk factors for poor quality of life (QOL).

SUMMARY OF BACKGROUND DATA

The aging of society has led to an increase in elderly people with chronic pain, including LBP and NeP. However, there has been no analysis of NeP and spinal sagittal alignment as potential risk factors for decreased QOL in the healthy general population.

METHODS

The subjects were 1128 people (male 473, female 655, average age: 64.3 yrs) who attended an annual health checkup in Yakumo study. The prevalence of LBP and sciatica were investigated using a visual analogue scale (VAS), and NeP was defined as more than or equal to 13 points on the painDETECT questionnaire. Sagittal spinal alignment with spinal ROM was also measured. Body mass index, muscle strength, physical ability, osteoporosis, and lumbar degenerative changes were measured, and 36-item short-form health survey (SF-36) was used for QOL analysis.

RESULTS

NeP was present in 113 people (10%). The NeP (+) subjects had significantly more severe pain, lower gait speed, higher osteoporosis rate, lumbar kyphosis, and larger spinal inclination (P < 0.01) compared with NeP (-) subjects. On SF-36, physical and mental QOL were significantly lower for NeP (+) subjects (P < 0.0001). In multivariate logistic regression analysis adjusted for age and sex, NeP (+) (odds ratio [OR]: 3.01), positive spinal inclination (OR: 1.14), and high VAS for LBP (OR: 1.04) were identified as risk factors for low physical QOL, and NeP (+) (OR: 5.32) was the only significant risk factor for low mental QOL.

CONCLUSION

These results suggest that interventions for NeP and other identified risk factors may contribute to improvement of low physical and mental QOL in middle-aged and elderly people.

LEVEL OF EVIDENCE

2.

Comparison of Postoperative Outcomes According to Compensatory Changes of the Thoracic Spine Among Patients With a T1 Slope More Than 40°

STUDY DESIGN

Retrospective study of postoperative outcomes of adult spinal deformity (ASD) surgery.

OBJECTIVE

To clarify the differences in postoperative outcomes depending on the presence or absence of thoracic compensatory changes among patients with a T1 slope (TS) more than 40°.

SUMMARY OF BACKGROUND DATA

Loss correction after ASD surgery is more likely to occur when preoperative TS is more than 40°. When preoperative TS is more than 40°, some cases involve compensatory changes in the thoracic spine and decreased thoracic kyphosis (TK); others involve increased TK without compensatory changes.

METHODS

Seventy-nine patients with TS more than 40° who underwent ASD surgery were enrolled and separated into compensated and noncompensated groups (group C: TK <40°; group NC: TK ≥40°). Radiographic parameters obtained by whole-spine standing x-ray, the Oswestry Disability Index (ODI), and Scoliosis Research Society-22 (SRS-22) questionnaire were assessed.

RESULTS

There were 41 patients in group C and 38 patients in group NC. Preoperative significant differences in TS did not disappear after surgery (preoperative TS: group C and group NC = 46° and 55°, P < 0.001; just after surgery: group C and group NC = 27° and 40°, P < 0.001; 2 years later: group C and group NC = 34° and 47°, P < 0.001). There were no significant differences in ODI and all domains of the SRS-22 before surgery. However, 2 years after the surgery, ODI (38%), pain (3.5), self-image (3.0), and total (3.2) values of the SRS-22 for group NC were significantly worse than those (28%, 4.0, 3.4, and 3.5, respectively) for group C (P < 0.05).

CONCLUSION

Changes in the thoracic spine (TS and TK >40°) result in poor postoperative outcomes. Extending the upper instrumented vertebra (UIV) to the upper thoracic spine must be considered. Even when TS is more than 40°, TK less than 40°, and upper instrumented vertebra set to the lower thoracic level result in good postoperative outcomes.

LEVEL OF EVIDENCE

3.