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
. 2023 Nov;66(6):611-617.
doi: 10.3340/jkns.2023.0146. Epub 2023 Aug 16.

The Sagittal Balance of Cervical Spine : Comprehensive Review of Recent Update

Sang Hoon Lee  1 , Tae Hwan Kim  2   3 , Seok Woo Kim  2   3 , Hyun Take Rim  1 , Heui Seung Lee  1 , Ji Hee Kim  1 , In Bok Chang  1 , Joon Ho Song  1 , Yong Kil Hong  1 , Jae Keun Oh  1   3
Affiliations

The Sagittal Balance of Cervical Spine : Comprehensive Review of Recent Update

Sang Hoon Lee et al. J Korean Neurosurg Soc. 2023 Nov.

Abstract

The cervical spine plays a critical role in supporting the skull, maintaining horizontal gaze, and facilitating walking. Its unique characteristics, including the widest range of motion among spinal segments, have led to extensive research on cervical sagittal alignment. Various parameters have been proposed to evaluate cervical alignment, with studies investigating their clinical significance, correlation with symptoms, and implications for surgical interventions. Recent findings suggest that cervical sagittal alignment not only impacts the cervical spine but also influences global spine-pelvic alignment through compensatory mechanisms. This comprehensive review examines classical and new parameters of cervical sagittal alignment and considers the dynamic and muscular factors associated with it.

Keywords: Cervical sagittal alignment; Cervical spine; Cervical spine deformity; Cervical spine parameter.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.
Cervical lordosis measurement methods. A : Modified Cobb method. The angle between lines drawn perpendicular to inferior endplates of C2 and C7. B : Jackson physiological stress lines. The angle between lines parallel to the posterior surfaces of the C2 and C7 vertebral bodies. C : Harrison's posterior tangent method, the sum of the angles for the overall cervical curvature is measured by lines parallel to the posterior surfaces of all cervical vertebral bodies from C2 to C7.
Fig. 2.
Fig. 2.
Comparison between TIA and PI. Greater TIA or T1S requires more CL, as greater PI requires more lumbar lordosis. TIA : thoracic inlet angle, NT : neck tilt, T1S : T1 slope, PI : pelvic incidence, PT : pelvic tilt, SS : sacral slope.
Fig. 3.
Fig. 3.
C2-7 SVA is distance between C2 plumb line and posterior, superior endplate of C7 body. SVA : sagittal vertical axis.
Fig. 4.
Fig. 4.
K-line tilt is the angle between line connecting the midpoints of the spinal canal at C2 and C7 and a vertical line.
See this image and copyright information in PMC

References

    1. Ames CP, Blondel B, Scheer JK, Schwab FJ, Le Huec JC, Massicotte EM, et al. Cervical radiographical alignment: comprehensive assessment techniques and potential importance in cervical myelopathy. Spine (Phila Pa 1976) 2013;38(22 Suppl 1):S149–S160. - PubMed
    1. Ames CP, Smith JS, Eastlack R, Blaskiewicz DJ, Shaffrey CI, Schwab F, et al. Reliability assessment of a novel cervical spine deformity classification system. J Neurosurg Spine. 2015;23:673–683. - PubMed
    1. Ames CP, Smith JS, Scheer JK, Bess S, Bederman SS, Deviren V, et al. Impact of spinopelvic alignment on decision making in deformity surgery in adults: a review. J Neurosurg Spine. 2012;16:547–564. - PubMed
    1. Buckland AJ, Vira S, Oren JH, Lafage R, Harris BY, Spiegel MA, et al. When is compensation for lumbar spinal stenosis a clinical sagittal plane deformity? Spine J. 2016;16:971–981. - PubMed
    1. Chen J, Wang J, Wei X, Guan H, Wang B, Xu H, et al. The importance of preoperative t1 slope for determining proper postoperative c2-7 cobb’s angle in patients undergoing cervical reconstruction. J Orthop Surg Res. 2020;15:507. - PMC - PubMed

LinkOut - more resources