Radiological features of degenerative cervical kyphosis and relationship between sagittal parameters_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHAI Zihao , YANG Xiaolu , ZHANG Wei , ZHANG Xu , HU Xiaoming , GUAN Yujun , ZHANG Haoran ,  YU Haiyang

Department of Orthopedics, Fuyang People’s Hospital of Anhui Medical University (Fuyang People’s Hospital), Spinal Deformity Clinical Medical Research Center of Anhui, Fuyang Anhui, 236000, P. R. China;

Corresponding?author：

YU Haiyang, Email: fy.yhy@163.com

Keywords：

Degenerative cervical kyphosis; inclination of zygapophyseal joints; sagittal parameters; kyphosis range; kyphosis focal

DOI：

10.7507/1002-1892.202205079

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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 C₀-C₂ angle, C₂-C₇ angle, C₃-C₇ inclination of zygapophyseal joints, C₇ slope (C₇S), 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 C₄-C₅ (78/89, 87.64%). The C₃-C₇ 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 C₀-C₂ angle, C₂-C₇ angle, C₇S, and cSVA were (–23.81±6.74)°, (10.15±2.94)°, (15.31±4.59)°, and (2.37±1.19) mm, respectively. The C₇S 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 C₀-C₂ angle (P<0.05), and positively correlated with C₂-C₇ angle and cSVA (P<0.05); VAS score was negatively correlated with C₇S (P<0.05). Except VAS, NDI and all cervical sagittal parameters were affected by age. Age was positively correlated with NDI, C₇S, and cSVA (P<0.05), and negatively correlated with C₀-C₂ angle and C₂-C₇ angle (P<0.05). The correlation analysis of cervical sagittal parameters showed that C₀-C₂ angle was negatively correlated with C₂-C₇ angle and cSVA (P<0.05); C₇S was negatively correlated with C₂-C₇ 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.

Citation： CHAI Zihao, YANG Xiaolu, ZHANG Wei, ZHANG Xu, HU Xiaoming, GUAN Yujun, ZHANG Haoran, YU Haiyang. Radiological features of degenerative cervical kyphosis and relationship between sagittal parameters. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(11): 1413-1419. doi: 10.7507/1002-1892.202205079 Copy

1.	崔維, 王磊, 麻松, 等. 頸前路經椎間隙后緣截骨治療退變性僵硬型頸椎后凸畸形. 首都醫科大學學報, 2019, 40(4): 497-502.
2.	Passias PG, Alas H, Lafage R, et al. Global spinal deformity from the upper cervical perspective. What is “Abnormal” in the upper cervical spine? J Craniovertebr Junction Spine, 2019, 10(3): 152-159.
3.	Abelin-Genevois K. Sagittal balance of the spine. Orthop Traumatol Surg Res, 2021, 107(1S): 102769. doi: 10.1016/j.otsr.2020.102769.
4.	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.
5.	吳炳軒, 劉寶戈, 崔維, 等. C₂及C₇傾斜角與退變性頸椎節段后凸矢狀位力線及臨床功能相關性研究. 中國脊柱脊髓雜志, 2021, 31(12): 1098-1105.
6.	Kim BJ, Cho SM, Hur JW, et al. Kinematics after cervical laminoplasty: risk factors for cervical kyphotic deformity after laminoplasty. Spine J, 2021, 21(11): 1822-1829.
7.	Lin T, Chen P, Wang Z, et al. Does cervical sagittal balance affect the preoperative neck disability index in patients with cervical myelopathy? Clin Spine Surg, 2020, 33(1): E21-E25.
8.	Nú?ez-Pereira S, Hitzl W, Bullmann V, et al. Sagittal balance of the cervical spine: an analysis of occipitocervical and spinopelvic interdependence, with C-7 slope as a marker of cervical and spinopelvic alignment. J Neurosurg Spine, 2015, 23(1): 16-23.
9.	Le Huec JC, Demezon H, Aunoble S. Sagittal parameters of global cervical balance using EOS imaging: normative values from a prospective cohort of asymptomatic volunteers. Eur Spine J, 2015, 24(1): 63-71.
10.	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.
11.	Lee HJ, Kim IS, Hong JT. Physiologic cervical alignment change between cervical spine X-ray and computed tomography. J Korean Neurosurg Soc, 2021, 64(5): 784-790.
12.	Le Huec JC, Thompson W, Mohsinaly Y, et al. Sagittal balance of the spine. Eur Spine J, 2019, 28(9): 1889-1905.
13.	韓渤, 陳宇翔, 海涌, 等. 頸椎矢狀位參數及其在常見脊柱疾病中應用的研究進展. 中華醫學雜志, 2021, 101(41): 3438-3442.
14.	席新華, 吳強, 唐華軍, 等. 成人下頸椎椎體與關節突關節傾角的X射線測量數據. 中國組織工程研究與臨床康復, 2009, 13(4): 662-666.
15.	沈曉龍, 田野, 東人, 等. 青少年特發性頸椎后凸畸形的影像學特征及其臨床指導意義. 中國脊柱脊髓雜志, 2011, 21(9): 745-749.
16.	Scheer JK, Tang JA, Smith JS, et al. Cervical spine alignment, sagittal deformity, and clinical implications: a review. J Neurosurg Spine, 2013, 19(2): 141-159.
17.	Chavanne A, Pettigrew DB, Holtz JR, et al. Spinal cord intramedullary pressure in cervical kyphotic deformity: a cadaveric study. Spine (Phila Pa 1976), 2011, 36(20): 1619-1626.
18.	周靈杰, 惲波, 殷建, 等. 頸椎后凸畸形患者頸椎曲度運動規律及與正常人重力線的比較. 南京醫科大學學報 (自然科學版), 2016, 36(9): 1111-1115.
19.	Wang X, Lindstroem R, Plocharski M, et al. Cervical flexion and extension includes anti-directional cervical joint motion in healthy adults. Spine J, 2018, 18(1): 147-154.
20.	Weng C, Wang J, Tuchman A, et al. Influence of T₁ slope on the cervical sagittal balance in degenerative cervical spine: An analysis using kinematic MRI. Spine (Phila Pa 1976), 2016, 41(3): 185-190.
21.	Hofler RC, Muriuki MG, Havey RM, et al. Neutral cervical sagittal vertical axis and cervical lordosis vary with T1 tilt. J Neurosurg Spine, 2020. doi: 10.3171/2020.2.SPINE191363.
22.	王典, 劉寶戈, 戎天華, 等. 表面肌電圖評估頸椎后凸畸形對頸部肌肉功能的影響. 中華骨科雜志, 2021, 41(13): 856-863.
23.	Cao J, Zhang J, Yang D, et al. Multivariate analysis of factors associated with kyphotic deformity after laminoplasty in cervical spondylotic myelopathy patients without preoperative kyphotic alignment. Sci Rep, 2017, 7: 43443. doi: 10.1038/srep43443.
24.	Patwardhan AG, Khayatzadeh S, Havey RM, et al. Cervical sagittal balance: a biomechanical perspective can help clinical practice. Eur Spine J, 2018, 27(Suppl 1): 25-38.
25.	Ramchandran S, Protopsaltis TS, Sciubba D, et al. Prospective multi-centric evaluation of upper cervical and infra-cervical sagittal compensatory alignment in patients with adult cervical deformity. Eur Spine J, 2018, 27(2): 416-425.
26.	Oh T, Scheer JK, Eastlack R, et al. Cervical compensatory alignment changes following correction of adult thoracic deformity: a multicenter experience in 57 patients with a 2-year follow-up. J Neurosurg Spine, 2015, 22(6): 658-665.
27.	Tamai K, Buser Z, Paholpak P, et al. Can C₇ slope substitute the T₁ slope?: An analysis using cervical radiographs and kinematic MRIs. Spine (Phila Pa 1976), 2018, 43(7): 520-525.
28.	Zhang L, Cheng Z, Zhang T, et al. Correlation between C₇ slope and cervical lordosis in patients after expansive open-door laminoplasty. Br J Neurosurg, 2020, 34(4): 419-422.
29.	Tang R, Ye IB, Cheung ZB, et al. Age-related changes in cervical sagittal alignment: A radiographic analysis. Spine (Phila Pa 1976), 2019, 44(19): E1144-E1150.
30.	劉承鑫, 李翔宇, 王宇, 等. 不同年齡頸椎病患者頸椎椎間盤退行性變與頸椎矢狀位參數之間的關系. 脊柱外科雜志, 2022, 20(2): 116-120.
31.	Diebo BG, Ferrero E, Lafage R, et al. Recruitment of compensatory mechanisms in sagittal spinal malalignment is age and regional deformity dependent: a full-standing axis analysis of key radiographical parameters. Spine (Phila Pa 1976), 2015, 40(9): 642-649.
32.	Oe S, Togawa D, Yoshida G, et al. Difference in spinal sagittal alignment and health-related quality of life between males and females with cervical deformity. Asian Spine J, 2017, 11(6): 959-967.

1. 崔維, 王磊, 麻松, 等. 頸前路經椎間隙后緣截骨治療退變性僵硬型頸椎后凸畸形. 首都醫科大學學報, 2019, 40(4): 497-502.
2. Passias PG, Alas H, Lafage R, et al. Global spinal deformity from the upper cervical perspective. What is “Abnormal” in the upper cervical spine? J Craniovertebr Junction Spine, 2019, 10(3): 152-159.
3. Abelin-Genevois K. Sagittal balance of the spine. Orthop Traumatol Surg Res, 2021, 107(1S): 102769. doi: 10.1016/j.otsr.2020.102769.
4. 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.
5. 吳炳軒, 劉寶戈, 崔維, 等. C₂及C₇傾斜角與退變性頸椎節段后凸矢狀位力線及臨床功能相關性研究. 中國脊柱脊髓雜志, 2021, 31(12): 1098-1105.
6. Kim BJ, Cho SM, Hur JW, et al. Kinematics after cervical laminoplasty: risk factors for cervical kyphotic deformity after laminoplasty. Spine J, 2021, 21(11): 1822-1829.
7. Lin T, Chen P, Wang Z, et al. Does cervical sagittal balance affect the preoperative neck disability index in patients with cervical myelopathy? Clin Spine Surg, 2020, 33(1): E21-E25.
8. Nú?ez-Pereira S, Hitzl W, Bullmann V, et al. Sagittal balance of the cervical spine: an analysis of occipitocervical and spinopelvic interdependence, with C-7 slope as a marker of cervical and spinopelvic alignment. J Neurosurg Spine, 2015, 23(1): 16-23.
9. Le Huec JC, Demezon H, Aunoble S. Sagittal parameters of global cervical balance using EOS imaging: normative values from a prospective cohort of asymptomatic volunteers. Eur Spine J, 2015, 24(1): 63-71.
10. 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.
11. Lee HJ, Kim IS, Hong JT. Physiologic cervical alignment change between cervical spine X-ray and computed tomography. J Korean Neurosurg Soc, 2021, 64(5): 784-790.
12. Le Huec JC, Thompson W, Mohsinaly Y, et al. Sagittal balance of the spine. Eur Spine J, 2019, 28(9): 1889-1905.
13. 韓渤, 陳宇翔, 海涌, 等. 頸椎矢狀位參數及其在常見脊柱疾病中應用的研究進展. 中華醫學雜志, 2021, 101(41): 3438-3442.
14. 席新華, 吳強, 唐華軍, 等. 成人下頸椎椎體與關節突關節傾角的X射線測量數據. 中國組織工程研究與臨床康復, 2009, 13(4): 662-666.
15. 沈曉龍, 田野, 東人, 等. 青少年特發性頸椎后凸畸形的影像學特征及其臨床指導意義. 中國脊柱脊髓雜志, 2011, 21(9): 745-749.
16. Scheer JK, Tang JA, Smith JS, et al. Cervical spine alignment, sagittal deformity, and clinical implications: a review. J Neurosurg Spine, 2013, 19(2): 141-159.
17. Chavanne A, Pettigrew DB, Holtz JR, et al. Spinal cord intramedullary pressure in cervical kyphotic deformity: a cadaveric study. Spine (Phila Pa 1976), 2011, 36(20): 1619-1626.
18. 周靈杰, 惲波, 殷建, 等. 頸椎后凸畸形患者頸椎曲度運動規律及與正常人重力線的比較. 南京醫科大學學報 (自然科學版), 2016, 36(9): 1111-1115.
19. Wang X, Lindstroem R, Plocharski M, et al. Cervical flexion and extension includes anti-directional cervical joint motion in healthy adults. Spine J, 2018, 18(1): 147-154.
20. Weng C, Wang J, Tuchman A, et al. Influence of T₁ slope on the cervical sagittal balance in degenerative cervical spine: An analysis using kinematic MRI. Spine (Phila Pa 1976), 2016, 41(3): 185-190.
21. Hofler RC, Muriuki MG, Havey RM, et al. Neutral cervical sagittal vertical axis and cervical lordosis vary with T1 tilt. J Neurosurg Spine, 2020. doi: 10.3171/2020.2.SPINE191363.
22. 王典, 劉寶戈, 戎天華, 等. 表面肌電圖評估頸椎后凸畸形對頸部肌肉功能的影響. 中華骨科雜志, 2021, 41(13): 856-863.
23. Cao J, Zhang J, Yang D, et al. Multivariate analysis of factors associated with kyphotic deformity after laminoplasty in cervical spondylotic myelopathy patients without preoperative kyphotic alignment. Sci Rep, 2017, 7: 43443. doi: 10.1038/srep43443.
24. Patwardhan AG, Khayatzadeh S, Havey RM, et al. Cervical sagittal balance: a biomechanical perspective can help clinical practice. Eur Spine J, 2018, 27(Suppl 1): 25-38.
25. Ramchandran S, Protopsaltis TS, Sciubba D, et al. Prospective multi-centric evaluation of upper cervical and infra-cervical sagittal compensatory alignment in patients with adult cervical deformity. Eur Spine J, 2018, 27(2): 416-425.
26. Oh T, Scheer JK, Eastlack R, et al. Cervical compensatory alignment changes following correction of adult thoracic deformity: a multicenter experience in 57 patients with a 2-year follow-up. J Neurosurg Spine, 2015, 22(6): 658-665.
27. Tamai K, Buser Z, Paholpak P, et al. Can C₇ slope substitute the T₁ slope?: An analysis using cervical radiographs and kinematic MRIs. Spine (Phila Pa 1976), 2018, 43(7): 520-525.
28. Zhang L, Cheng Z, Zhang T, et al. Correlation between C₇ slope and cervical lordosis in patients after expansive open-door laminoplasty. Br J Neurosurg, 2020, 34(4): 419-422.
29. Tang R, Ye IB, Cheung ZB, et al. Age-related changes in cervical sagittal alignment: A radiographic analysis. Spine (Phila Pa 1976), 2019, 44(19): E1144-E1150.
30. 劉承鑫, 李翔宇, 王宇, 等. 不同年齡頸椎病患者頸椎椎間盤退行性變與頸椎矢狀位參數之間的關系. 脊柱外科雜志, 2022, 20(2): 116-120.
31. Diebo BG, Ferrero E, Lafage R, et al. Recruitment of compensatory mechanisms in sagittal spinal malalignment is age and regional deformity dependent: a full-standing axis analysis of key radiographical parameters. Spine (Phila Pa 1976), 2015, 40(9): 642-649.
32. Oe S, Togawa D, Yoshida G, et al. Difference in spinal sagittal alignment and health-related quality of life between males and females with cervical deformity. Asian Spine J, 2017, 11(6): 959-967.

Chinese Journal of Reparative and Reconstructive Surgery

Radiological features of degenerative cervical kyphosis and relationship between sagittal parameters

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