Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Feb;33(1):E21-E25.
doi: 10.1097/BSD.0000000000000916.

Does Cervical Sagittal Balance Affect the Preoperative Neck Disability Index in Patients With Cervical Myelopathy?

Taotao Lin  1 , Penghong Chen, Zhenyu Wang, Gang Chen, Wenge Liu
Affiliations

Does Cervical Sagittal Balance Affect the Preoperative Neck Disability Index in Patients With Cervical Myelopathy?

Taotao Lin et al. Clin Spine Surg. 2020 Feb.

Abstract

Study design: This was a retrospective study.

Objective: This study aimed to ascertain the relationship between preoperative Neck Disability Index (NDI) scores and cervical sagittal alignment in patients with cervical spondylotic myelopathy (CSM).

Summary of background data: Cervical alignment may influence postoperative clinical outcomes. However, the effect of preoperative sagittal balance on the preoperative status in CSM patients remains uncertain.

Materials and methods: From 2010 to 2016, 90 patients who underwent cervical surgery for CSM were enrolled. The inclusion criteria for this study included preoperative standing cervical radiographs and a preoperative NDI score. The following radiographic parameters were measured: (1) C0-C2 lordosis, (2) C2-C7 lordosis, (3) C2-C7 sagittal vertical axis (SVA), (4) neck tilt, (5) thoracic inlet angle, (6) T1 slope, and (7) T1 slope minus cervical lordosis (T1S-CL). The Pearson product-moment correlation coefficients were calculated between all radiographic variables and the NDI scores, and multiple regression analysis was performed to determine the independent predictors of high preoperative NDI scores.

Results: Both C2-C7 SVA and T1S-CL were positively correlated with NDI scores (r=0.732, P<0.001 and r=0.333, P=0.001). Cervical lordosis was negatively correlated with NDI scores (r=-0.267, P=0.011). Significant correlations were found between C2-C7 SVA and the C0-C2 Cobb angle (r=0.244, P=0.020), C2-C7 SVA and the C2-C7 Cobb angle (r=-0.359, P=0.001), the C2-C7 Cobb angle and the C0-C2 Cobb angle (r=-0.457, P<0.001), and the C2-C7 Cobb angle and T1 slope (r=-0.385, P<0.001).

Conclusions: The disability of the neck increased with increasing C2-C7 SVA and T1S-CL and decreasing cervical lordosis before surgical reconstruction. High C2-C7 SVA, low thoracic inlet angle, and high neck tilt values are independent predictors of high preoperative NDI scores.

PubMed Disclaimer

References

    1. 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.
    1. Ferrara LA. The biomechanics of cervical spondylosis. Adv Orthop. 2012;2012:493605.
    1. Iyer S, Nemani VM, Nguyen J, et al. Impact of cervical sagittal alignment parameters on neck disability. Spine (Phila Pa 1976). 2016;41:371–377.
    1. Iyer S, Lenke LG, Nemani VM, et al. Variations in sagittal alignment parameters based on age: a prospective study of asymptomatic volunteers using full-body radiographs. Spine (Phila Pa 1976). 2016;41:1826–1836.
    1. Patwardhan AG, Havey RM, Khayatzadeh S, et al. Postural consequences of cervical sagittal imbalance: a novel laboratory model. Spine (Phila Pa 1976). 2015;40:783–792.