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.	崔维, 王磊, 麻松, 等. 颈前路经椎间隙后缘截骨治疗退变性僵硬型颈椎后凸畸形. 首都医科大学学报, 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.	赵文奎, 于淼, 韦峰, 等. 无症状成人颈椎矢状位曲度分析及其与全脊柱矢状位参数的关系. 中国脊柱脊髓杂志, 2015, 25(3): 231-238.
5.	吴炳轩, 刘宝戈, 崔维, 等. C₂及C₇倾斜角与退变性颈椎节段后凸矢状位力线及临床功能相关性研究. 中国脊柱脊髓杂志, 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.	Núñez-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.	韩渤, 陈宇翔, 海涌, 等. 颈椎矢状位参数及其在常见脊柱疾病中应用的研究进展. 中华医学杂志, 2021, 101(41): 3438-3442.
14.	席新华, 吴强, 唐华军, 等. 成人下颈椎椎体与关节突关节倾角的X射线测量数据. 中国组织工程研究与临床康复, 2009, 13(4): 662-666.
15.	沈晓龙, 田野, 东人, 等. 青少年特发性颈椎后凸畸形的影像学特征及其临床指导意义. 中国脊柱脊髓杂志, 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.	周灵杰, 恽波, 殷建, 等. 颈椎后凸畸形患者颈椎曲度运动规律及与正常人重力线的比较. 南京医科大学学报 (自然科学版), 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, 刘宝戈, 戎天华, 等. 表面肌电图评估颈椎后凸畸形对颈部肌肉功能的影响. 中华骨科杂志, 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.	刘承鑫, 李翔宇, 王宇, 等. 不同年龄颈椎病患者颈椎椎间盘退行性变与颈椎矢状位参数之间的关系. 脊柱外科杂志, 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. 崔维, 王磊, 麻松, 等. 颈前路经椎间隙后缘截骨治疗退变性僵硬型颈椎后凸畸形. 首都医科大学学报, 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. 赵文奎, 于淼, 韦峰, 等. 无症状成人颈椎矢状位曲度分析及其与全脊柱矢状位参数的关系. 中国脊柱脊髓杂志, 2015, 25(3): 231-238.
5. 吴炳轩, 刘宝戈, 崔维, 等. C₂及C₇倾斜角与退变性颈椎节段后凸矢状位力线及临床功能相关性研究. 中国脊柱脊髓杂志, 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. Núñez-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. 韩渤, 陈宇翔, 海涌, 等. 颈椎矢状位参数及其在常见脊柱疾病中应用的研究进展. 中华医学杂志, 2021, 101(41): 3438-3442.
14. 席新华, 吴强, 唐华军, 等. 成人下颈椎椎体与关节突关节倾角的X射线测量数据. 中国组织工程研究与临床康复, 2009, 13(4): 662-666.
15. 沈晓龙, 田野, 东人, 等. 青少年特发性颈椎后凸畸形的影像学特征及其临床指导意义. 中国脊柱脊髓杂志, 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. 周灵杰, 恽波, 殷建, 等. 颈椎后凸畸形患者颈椎曲度运动规律及与正常人重力线的比较. 南京医科大学学报 (自然科学版), 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, 刘宝戈, 戎天华, 等. 表面肌电图评估颈椎后凸畸形对颈部肌肉功能的影响. 中华骨科杂志, 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. 刘承鑫, 李翔宇, 王宇, 等. 不同年龄颈椎病患者颈椎椎间盘退行性变与颈椎矢状位参数之间的关系. 脊柱外科杂志, 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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