Analysis of cervical sagittal parameters on MRI in patients with cervical spondylotic myelopathy_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Lilong ¹ , CHENG Zhaojun ^1,2 , CUI Zijian ¹ , REN Zhishuai ¹ , PENG Bing ^1,2 ,  ZHANG Xueli ¹

1. No.1 Department of Spine Surgery, Tianjin Union Medical Center, Tianjin, 300121, P.R.China;
2. Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, P.R.China;

Corresponding?author：

ZHANG Xueli, Email: zxlspine@163.com

Keywords：

T₁ slope; cervical sagittal parameter; cervical spondylotic myelopathy; correlation analysis

DOI：

10.7507/1002-1892.201610119

Video：

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Objective To analyse the correlation between cervical sagittal parameters of cervical spondylotic myelopathy in different sagittal curvature so as to find out representative cervical sagittal alignment parameters by measuring on MRI. Methods A retrospective analysis was made on the clinical data of 88 patients with cervical spondylotic myelopathy between July 2015 and January 2016. The C₂-C₇ Cobb angle, T₁ slope (T₁S), and C₂-C₇ sagittal vertical axis (C₂-C₇ SVA) were measured on T2-weight MRI. According to C₂-C₇ Cobb angle, the patients were divided into lordosis group (≥10° Cobb angle, 48 cases) and straightened group (0-10° Cobb angle, 40 cases). Intraclass correlation coefficient (ICC) was used for the reliability of measured data, Pearson correlation analysis for correlation between cervical sagittal parameters. Results ICC was 0.858-0.946, indicating good consistency of measurement parameters. The C₂-C₇ Cobb angle, T₁S, and C₂-C₇ SVA were (5.6±2.4)°, (22.2±6.7)°, and (10.2±5.4) mm in straightened group, and were (20.1±8.2)°, (23.4±8.9)°, and (8.2±4.6) mm in lordosis group respectively. There was no correlation between the 3 parameters in straighten group (r=0.100,P=0.510 for T₁S and C₂-C₇ Cobb angle;r=–0.100,P=0.500 for T₁S and C₂-C₇ SVA;r=0.080,P=0.610 for C₂-C₇ Cobb angle and C₂-C₇ SVA). There was positive correlation between T₁S and C₂-C₇ Cobb angle (r=0.540,P=0.000), negative correlation between T₁S and C₂-C₇ SVA (r=–0.450,P=0.001), and no correlation between C₂-C₇ Cobb angle and C₂-C₇ SVA (r=–0.003,P=0.980). Conclusion For cervical spondylotic myelopathy in patients with cervical lordosis, only T₁S measurement on MRI can be used as the main parameter to judge the sagittal curvature, but in patients with straightened cervical Cobb angle, measurements of T₁S, C₂-C₇ Cobb angle, and C₂-C₇ SVA should be taken for the comprehensive evaluation of cervical sagittal curvature.

Citation： ZHANG Lilong, CHENG Zhaojun, CUI Zijian, REN Zhishuai, PENG Bing, ZHANG Xueli. Analysis of cervical sagittal parameters on MRI in patients with cervical spondylotic myelopathy. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(4): 451-454. doi: 10.7507/1002-1892.201610119 Copy

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2.	Vaz G, Roussouly P, Berthonnaud E, et al. Sagittal morphology and equilibrium of pelvis and spine. Eur Spine J, 2002, 11(1): 80-87.
3.	Vialle R, Levassor N, Rillardon L, et al. Radiographic analysis of the sagittal alignment and balance of the spine in asymptomatic subjects. J Bone Joint Surg (Am), 2005, 87(2): 260-267.
4.	Boulay C, Tardieu C, Hecquet J, et al. Sagittal alignment of spine and pelvis regulated by pelvic incidence: standard values and prediction of lordosis. Eur Spine J, 2006, 15(4): 415-422.
5.	Jang JS, Lee SH, Min JH, et al. Surgical treatment of failed back surgery syndrome due to sagittal imbalance. Spine (Phila Pa 1976), 2007, 32(26): 3081-3087.
6.	張奎渤, 詹鴻銳, 于兵, 等. X 線與 CT 影像學測量成人頸椎矢狀面參數的差異. 第三軍醫大學學報, 2015, 37(19): 1997-2000.
7.	Kim TH, Lee SY, Kim YC, et al. T₁ slope as a predictor of kyphotic alignment change after laminoplasty in patients with cervical myelopathy. Spine (Phila Pa 1976), 2013, 38(16): E992-997.
8.	Berthonnaud E, Dimnet J, Roussouly P, et al. Analysis of the sagittal balance of the spine and pelvis using shape and orientation parameters. J Spinal Disord Tech, 2005, 18(1): 40-47.
9.	Wang ZL, Xiao JL, Mou JH, et al. Analysis of Cervical Sagittal Balance Parameters in MRIs of Patients with Disc-Degenerative Disease. Med Sci Monit, 2015, 21: 3083-3088.
10.	Patwardhan AG, Khayatzadeh S, Nguyen NL, et al. Is Cervical Sagittal Imbalance a Risk Factor for Adjacent Segment Pathomechanics After Multilevel Fusion? Spine (Phila Pa 1976), 2016, 41(10): E580-588.
11.	任龍喜, 何玉寶, 郭函, 等. 頸部疼痛程度與頸椎曲度相關性的臨床觀察. 中國脊柱脊髓雜志, 2011, 21(9): 750-753.
12.	鄧元, 倪斌. 頸椎矢狀序列測量方法的研究進展. 中國脊柱脊髓雜志, 2014, 24(7): 655-659.
13.	Youn MS, Shin JK, Goh TS, et al. Relationship between cervical sagittal alignment and health-related quality of life in adolescent idiopathic scoliosis. Eur Spine J, 2016, 25(10): 3114-3119.
14.	Tang JA, Scheer JK, Smith JS, et al. The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery. Neurosurgery, 2015, 76 Suppl 1: S14-21, S21.
15.	Harrison DE, Harrison DD, Cailliet R, et al. Radiographic analysis of lumbar lordosis: centroid, Cobb, TRALL, and Harrison posterior tangent methods. Spine (Phila Pa 1976), 2001, 26(11): E235-242.
16.	Lee SH, Kim KT, Seo EM, et al. The influence of thoracic inlet alignment on the craniocervical sagittal balance in asymptomatic adults. J Spinal Disord Tech, 2012, 25(2): E41-47.
17.	福嘉欣, 江毅, 江漢, 等. T₁ 斜坡角度與頸后路單開門椎管擴大成形術后頸椎曲度變化關系的探討. 中國矯形外科雜志, 2015, 23(15): 1360-1364.
18.	Jun HS, Chang IB, Song JH, et al. Is it possible to evaluate the parameters of cervical sagittal alignment on cervical computed tomographic scans? Spine (Phila Pa 1976), 2014, 39(10): E630-636.
19.	Qiao J, Zhu F, Liu Z,et al. Measurement of Thoracic Inlet Alignment on MRI: Reliability and the Influence of Body Position. Clin Spine Surg, 2016. [Epub ahead of print].
20.	趙文奎, 于淼, 韋峰, 等. 無癥狀成人頸椎矢狀位曲度分析及其與全脊柱矢狀位參數的關系. 中國脊柱脊髓雜志, 2015, 25(3): 231-238.
21.	Park JH, Cho CB, Song JH, et al. T₁ Slope and Cervical Sagittal Alignment on Cervical CT Radiographs of Asymptomatic Persons. J Korean Neurosurg Soc, 2013, 53(6): 356-359.

1. ?Berthonnaud E, Dimnet J, Roussouly P, et al. Analysis of the sagittal balance of the spine and pelvis using shape and orientation parameters. J Spinal Disord Tech, 2005, 18(1): 40-47.
2. Vaz G, Roussouly P, Berthonnaud E, et al. Sagittal morphology and equilibrium of pelvis and spine. Eur Spine J, 2002, 11(1): 80-87.
3. Vialle R, Levassor N, Rillardon L, et al. Radiographic analysis of the sagittal alignment and balance of the spine in asymptomatic subjects. J Bone Joint Surg (Am), 2005, 87(2): 260-267.
4. Boulay C, Tardieu C, Hecquet J, et al. Sagittal alignment of spine and pelvis regulated by pelvic incidence: standard values and prediction of lordosis. Eur Spine J, 2006, 15(4): 415-422.
5. Jang JS, Lee SH, Min JH, et al. Surgical treatment of failed back surgery syndrome due to sagittal imbalance. Spine (Phila Pa 1976), 2007, 32(26): 3081-3087.
6. 張奎渤, 詹鴻銳, 于兵, 等. X 線與 CT 影像學測量成人頸椎矢狀面參數的差異. 第三軍醫大學學報, 2015, 37(19): 1997-2000.
7. Kim TH, Lee SY, Kim YC, et al. T₁ slope as a predictor of kyphotic alignment change after laminoplasty in patients with cervical myelopathy. Spine (Phila Pa 1976), 2013, 38(16): E992-997.
8. Berthonnaud E, Dimnet J, Roussouly P, et al. Analysis of the sagittal balance of the spine and pelvis using shape and orientation parameters. J Spinal Disord Tech, 2005, 18(1): 40-47.
9. Wang ZL, Xiao JL, Mou JH, et al. Analysis of Cervical Sagittal Balance Parameters in MRIs of Patients with Disc-Degenerative Disease. Med Sci Monit, 2015, 21: 3083-3088.
10. Patwardhan AG, Khayatzadeh S, Nguyen NL, et al. Is Cervical Sagittal Imbalance a Risk Factor for Adjacent Segment Pathomechanics After Multilevel Fusion? Spine (Phila Pa 1976), 2016, 41(10): E580-588.
11. 任龍喜, 何玉寶, 郭函, 等. 頸部疼痛程度與頸椎曲度相關性的臨床觀察. 中國脊柱脊髓雜志, 2011, 21(9): 750-753.
12. 鄧元, 倪斌. 頸椎矢狀序列測量方法的研究進展. 中國脊柱脊髓雜志, 2014, 24(7): 655-659.
13. Youn MS, Shin JK, Goh TS, et al. Relationship between cervical sagittal alignment and health-related quality of life in adolescent idiopathic scoliosis. Eur Spine J, 2016, 25(10): 3114-3119.
14. Tang JA, Scheer JK, Smith JS, et al. The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery. Neurosurgery, 2015, 76 Suppl 1: S14-21, S21.
15. Harrison DE, Harrison DD, Cailliet R, et al. Radiographic analysis of lumbar lordosis: centroid, Cobb, TRALL, and Harrison posterior tangent methods. Spine (Phila Pa 1976), 2001, 26(11): E235-242.
16. Lee SH, Kim KT, Seo EM, et al. The influence of thoracic inlet alignment on the craniocervical sagittal balance in asymptomatic adults. J Spinal Disord Tech, 2012, 25(2): E41-47.
17. 福嘉欣, 江毅, 江漢, 等. T₁ 斜坡角度與頸后路單開門椎管擴大成形術后頸椎曲度變化關系的探討. 中國矯形外科雜志, 2015, 23(15): 1360-1364.
18. Jun HS, Chang IB, Song JH, et al. Is it possible to evaluate the parameters of cervical sagittal alignment on cervical computed tomographic scans? Spine (Phila Pa 1976), 2014, 39(10): E630-636.
19. Qiao J, Zhu F, Liu Z,et al. Measurement of Thoracic Inlet Alignment on MRI: Reliability and the Influence of Body Position. Clin Spine Surg, 2016. [Epub ahead of print].
20. 趙文奎, 于淼, 韋峰, 等. 無癥狀成人頸椎矢狀位曲度分析及其與全脊柱矢狀位參數的關系. 中國脊柱脊髓雜志, 2015, 25(3): 231-238.
21. Park JH, Cho CB, Song JH, et al. T₁ Slope and Cervical Sagittal Alignment on Cervical CT Radiographs of Asymptomatic Persons. J Korean Neurosurg Soc, 2013, 53(6): 356-359.

Chinese Journal of Reparative and Reconstructive Surgery

Analysis of cervical sagittal parameters on MRI in patients with cervical spondylotic myelopathy

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