CHANGE AND CLINICAL SIGNIFICANCE OF CERVICAL SPINE SAGITTAL ALIGNMENT OF ADOLESCENT IDIOPATHIC SCOLIOSIS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YEFeng , SHIJianxiong , HUJianxin , HUANGBo , QIUHao ,  CHUTongwei

Department of Orthopedics, Xinqiao Hospital, Third Military Medical University, Chongqing, 400030, P.R.China;

Corresponding author：

CHUTongwei, Email: chtw@sina.com

Keywords：

Adolescent idiopathic scoliosis; Spinal-pelvic sagittal parameter; Cervical sagittal alignment

DOI：

10.7507/1002-1892.20160066

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Objective To investigate the changes and relationship of cervical spine sagittal alignment and other spinal-pelvic sagittal parameters in adolescent idiopathic scoliosis. Methods Between July 2011 and July 2014, 35 patients with idiopathic scoliosis who met the inclusion criteria underwent posterior pedicle screw instrumentation and fusion. There were 12 males and 23 females with a mean age of 16.2 years (range, 13-20 years), including 16 cases of Lenke type 1, 7 cases of Lenke type 2, 4 cases of Lenke type 3, 3 cases of Lenke type 4, 4 cases of Lenke type 5, and 1 case of Lenke type 6. The average follow-up time was 10.9 months (range, 5-36 months). The pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), cervical lordosis (CL), T₁ slope, C₂ slope, C₇ sagittal vertical axis (C₇ SVA), C_2-7 plumbline (cSVA) were measured on pre-and post-operative standing lateral X-ray film. Based on preoperative CL, the patients were divided into kyphosis group (CL>0°) and lordosis group (CL < 0°); after operation, the patients were divided into restored lordosis (group A), decreased kyphosis (group B), and increased lordosis (group C) after operation. All data about sagittal profile changes were analyzed. The relations between CL and other spinal-pelvic parameters in the kyphosis and lordosis groups before operation were determined via Spearman correlation coefficient. Results Statistically significant changes were observed in PT, PI, SS, and LL between at pre-and post-operation (P < 0.05), but no significant difference was found in the other parameters (P>0.05). There were 17 patients in lordosis group and 18 in kyphosis group before operation. Intra-group comparisons showed significant changes in PT, PI, SS, C₂ slope, and C₇ SVA in lordosis group, and in PT, PI, SS, LL, CL, TK, T₁ slope, and C₂ slope in kyphosis group (P < 0.05). Subgroup comparisons showed significant changes in CL, TK, C₂ slope, C₇ SVA, and T₁ slope before operation (P < 0.05) and T₁ slope at last follow-up between 2 groups (P < 0.05). In kyphosis group, 7 cases (group A) had restored lordosis, 7 cases (group B) had decreased kyphosis, and 4 cases had increased lordosis. In lordosis group, 9 cases (group C) had increased lordosis, 3 cases had decreased lordosis, and 5 cases had kyphotic cervical alignment after operation. Significant difference was found in LL, CL, T₁ slope, C₂ slope, and C₇ SVA of group A, in TK and CL of group B, and in CL and cSVA of group C between pre-and post-operation (P < 0.05). There were significant differences in pre-and post-operative LL between groups A and B (P < 0.05). In lordosis group, there was a strong correlation between CL and C₂ slope (P < 0.05) at pre-operation. CL had strong correlation with C₂ slope and T₁ slope (P < 0.05) at pre-operation in kyphosis group, and CL had moderate correlation with cSVA (P < 0.05). Conclusion Cervical sagittal alignment plays an important role in the balance of the spine and pelvis. The change of cervical sagittal alignment has a certain correlation with the change of thoracic kyphosis. Attention to properly maintaining or restoring cervical sagittal lordosis alignment should be considered in preoperative evaluation of adolescent indiopathic scoliosis.

Citation： YEFeng, SHIJianxiong, HUJianxin, HUANGBo, QIUHao, CHUTongwei. CHANGE AND CLINICAL SIGNIFICANCE OF CERVICAL SPINE SAGITTAL ALIGNMENT OF ADOLESCENT IDIOPATHIC SCOLIOSIS. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(3): 336-342. doi: 10.7507/1002-1892.20160066 Copy

1.	La Maida GA, Zottarelli L, Mineo GV, et al. Sagittal balance in adolescent idiopathic scoliosis: radiographic study of spino-pelvic compensation after surgery. Eur Spine J, 2013, 22 Suppl 6: S859-S867.
2.	Roussouly P, Labelle H, Rouissi J, et al. Pre-and post-operative sagittal balance in idiopathic scoliosis: a comparison over the ages of two cohorts of 132 adolescents and 52 adults. Eur Spine J, 2013, 22 Suppl 2: S203-S215.
3.	Vidal C, Ilharreborde B, Azoulay R, et al. Reliability of cervical lordosis and global sagittal spinal balance measurements in adolescent idiopathic scoliosis. Eur Spine J, 2013, 22(6): 1362-1367.
4.	Glassman SD, Berven S, Bridwell K, et al. Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine (Phila Pa 1976), 2005, 30(6): 682-688.
5.	Mac-Thiong JM, Transfeldt EE, Mehbod AA, et al. Can c7 plumbline and gravity line predict health related quality of life in adult scoliosis? Spine (Phila Pa 1976), 2009, 34(15): E519-E527.
6.	Knott PT, Mardjetko SM, Techy F. The use of the T1 sagittal angle in predicting overall sagittal balance of the spine. Spine J, 2010, 10(11): 994-998.
7.	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-S21.
8.	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.
9.	Gore DR, Sepic SB, Gardner GM. Roentgenographic findings of the cervical spine in asymptomatic people. Spine (Phila Pa 1976), 1986, 11(6): 521-524.
10.	Lee SH, Son ES, Seo EM, et al. Factors determining cervical spine sagittal balance in asymptomatic adults: correlation with spinopelvic balance and thoracic inlet alignment. Spine J, 2015, 15(4): 705-712.
11.	Tanguay F, Mac-Thiong JM, de Guise JA, et al. Relation between the sagittal pelvic and lumbar spine geometries following surgical correction of adolescent idiopathic scoliosis. Eur Spine J, 2007, 16(4): 531-536.
12.	Clément JL, Geoffray A, Yagoubi F, et al. Relationship between thoracic hypokyphosis, lumbar lordosis and sagittal pelvic parameters in adolescent idiopathic scoliosis. Eur Spine J, 2013, 22(11): 2414-2420.
13.	Newton PO, Yaszay B, Upasani VV, et al. Preservation of thoracic kyphosis is critical to maintain lumbar lordosis in the surgical treatment of adolescent idiopathic scoliosis. Spine (Phila Pa 1976), 2010, 35(14): 1365-1370.
14.	Hilibrand AS, Tannenbaum DA, Graziano GP, et al. The sagittal alignment of the cervical spine in adolescent idiopathic scoliosis. J Pediatr Orthop, 1995, 15(5): 627-632.
15.	Hwang SW, Samdani AF, Tantorski M, et al. Cervical sagittal plane decompensation after surgery for adolescent idiopathic scoliosis: an effect imparted by postoperative thoracic hypokyphosis. J Neurosurg Spine, 2011, 15(5): 491-496.
16.	Canavese F, Turcot K, De Rosa V, et al. Cervical spine sagittal alignment variations following posterior spinal fusion and instrumentation for adolescent idiopathic scoliosis. Eur Spine J, 2011, 20(7): 1141-1148.
17.	Smith JS, Shaffrey CI, Lafage V, et al. Spontaneous improvement of cervical alignment after correction of global sagittal balance following pedicle subtraction osteotomy. J Neurosurg Spine, 2012, 17(4): 300-307.
18.	Kim YJ, Bridwell KH, Lenke LG, et al. Results of lumbar pedicle subtraction osteotomies for fixed sagittal imbalance: a minimum 5-year follow-up study. Spine (Phila Pa 1976), 2007, 32(20): 2189-2197.
19.	Yagi M, Iizuka S, Hasegawa A, et al. Sagittal cervical alignment in adolescent idiopathic scoliosis. Spine Deformity, 2014, 2(2): 122-130.
20.	Matsumoto M, Fujimura Y, Suzuki N, et al. Cervical curvature in acute whiplash injuries: prospective comparative study with asymptomatic subjects. Injury, 1998, 29(10): 775-778.
21.	McAviney J, Schulz D, Bock R, et al. Determining the relationship between cervical lordosis and neck complaints. J Manipulative Physiol Ther, 2005, 28(3): 187-193.
22.	Okada E, Matsumoto M, Ichihara D, et al. Does the sagittal alignment of the cervical spine have an impact on disk degeneration? Minimum 10-year follow-up of asymptomatic volunteers. Eur Spine J, 2009, 18(11): 1644-1651.
23.	Villavicencio AT, Babuska JM, Ashton A, et al. Prospective, randomized, double-blind clinical study evaluating the correlation of clinical outcomes and cervical sagittal alignment. Neurosurgery, 2011, 68(5): 1309-1316.
24.	Steinmetz MP, Stewart TJ, Kager CD, et al. Cervical deformity correction. Neurosurgery, 2007, 60(1 Supp1 1): S90-S97.

1. La Maida GA, Zottarelli L, Mineo GV, et al. Sagittal balance in adolescent idiopathic scoliosis: radiographic study of spino-pelvic compensation after surgery. Eur Spine J, 2013, 22 Suppl 6: S859-S867.
2. Roussouly P, Labelle H, Rouissi J, et al. Pre-and post-operative sagittal balance in idiopathic scoliosis: a comparison over the ages of two cohorts of 132 adolescents and 52 adults. Eur Spine J, 2013, 22 Suppl 2: S203-S215.
3. Vidal C, Ilharreborde B, Azoulay R, et al. Reliability of cervical lordosis and global sagittal spinal balance measurements in adolescent idiopathic scoliosis. Eur Spine J, 2013, 22(6): 1362-1367.
4. Glassman SD, Berven S, Bridwell K, et al. Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine (Phila Pa 1976), 2005, 30(6): 682-688.
5. Mac-Thiong JM, Transfeldt EE, Mehbod AA, et al. Can c7 plumbline and gravity line predict health related quality of life in adult scoliosis? Spine (Phila Pa 1976), 2009, 34(15): E519-E527.
6. Knott PT, Mardjetko SM, Techy F. The use of the T1 sagittal angle in predicting overall sagittal balance of the spine. Spine J, 2010, 10(11): 994-998.
7. 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-S21.
8. 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.
9. Gore DR, Sepic SB, Gardner GM. Roentgenographic findings of the cervical spine in asymptomatic people. Spine (Phila Pa 1976), 1986, 11(6): 521-524.
10. Lee SH, Son ES, Seo EM, et al. Factors determining cervical spine sagittal balance in asymptomatic adults: correlation with spinopelvic balance and thoracic inlet alignment. Spine J, 2015, 15(4): 705-712.
11. Tanguay F, Mac-Thiong JM, de Guise JA, et al. Relation between the sagittal pelvic and lumbar spine geometries following surgical correction of adolescent idiopathic scoliosis. Eur Spine J, 2007, 16(4): 531-536.
12. Clément JL, Geoffray A, Yagoubi F, et al. Relationship between thoracic hypokyphosis, lumbar lordosis and sagittal pelvic parameters in adolescent idiopathic scoliosis. Eur Spine J, 2013, 22(11): 2414-2420.
13. Newton PO, Yaszay B, Upasani VV, et al. Preservation of thoracic kyphosis is critical to maintain lumbar lordosis in the surgical treatment of adolescent idiopathic scoliosis. Spine (Phila Pa 1976), 2010, 35(14): 1365-1370.
14. Hilibrand AS, Tannenbaum DA, Graziano GP, et al. The sagittal alignment of the cervical spine in adolescent idiopathic scoliosis. J Pediatr Orthop, 1995, 15(5): 627-632.
15. Hwang SW, Samdani AF, Tantorski M, et al. Cervical sagittal plane decompensation after surgery for adolescent idiopathic scoliosis: an effect imparted by postoperative thoracic hypokyphosis. J Neurosurg Spine, 2011, 15(5): 491-496.
16. Canavese F, Turcot K, De Rosa V, et al. Cervical spine sagittal alignment variations following posterior spinal fusion and instrumentation for adolescent idiopathic scoliosis. Eur Spine J, 2011, 20(7): 1141-1148.
17. Smith JS, Shaffrey CI, Lafage V, et al. Spontaneous improvement of cervical alignment after correction of global sagittal balance following pedicle subtraction osteotomy. J Neurosurg Spine, 2012, 17(4): 300-307.
18. Kim YJ, Bridwell KH, Lenke LG, et al. Results of lumbar pedicle subtraction osteotomies for fixed sagittal imbalance: a minimum 5-year follow-up study. Spine (Phila Pa 1976), 2007, 32(20): 2189-2197.
19. Yagi M, Iizuka S, Hasegawa A, et al. Sagittal cervical alignment in adolescent idiopathic scoliosis. Spine Deformity, 2014, 2(2): 122-130.
20. Matsumoto M, Fujimura Y, Suzuki N, et al. Cervical curvature in acute whiplash injuries: prospective comparative study with asymptomatic subjects. Injury, 1998, 29(10): 775-778.
21. McAviney J, Schulz D, Bock R, et al. Determining the relationship between cervical lordosis and neck complaints. J Manipulative Physiol Ther, 2005, 28(3): 187-193.
22. Okada E, Matsumoto M, Ichihara D, et al. Does the sagittal alignment of the cervical spine have an impact on disk degeneration? Minimum 10-year follow-up of asymptomatic volunteers. Eur Spine J, 2009, 18(11): 1644-1651.
23. Villavicencio AT, Babuska JM, Ashton A, et al. Prospective, randomized, double-blind clinical study evaluating the correlation of clinical outcomes and cervical sagittal alignment. Neurosurgery, 2011, 68(5): 1309-1316.
24. Steinmetz MP, Stewart TJ, Kager CD, et al. Cervical deformity correction. Neurosurgery, 2007, 60(1 Supp1 1): S90-S97.

Chinese Journal of Reparative and Reconstructive Surgery

CHANGE AND CLINICAL SIGNIFICANCE OF CERVICAL SPINE SAGITTAL ALIGNMENT OF ADOLESCENT IDIOPATHIC SCOLIOSIS

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