Abstract
Purpose
To evaluate the effect of cervical sagittal alignment on craniocervical junction kinematic.
Methods
We retrospectively reviewed 359 patients (119 cervical lordosis, 38 cervical sagittal imbalances, 111 cervical straight, and 91 cervical kyphosis) who underwent cervical spine multi-positional magnetic resonance imaging (mMRI). The C2-7 angle, disc degeneration grading and cSVA were analyzed in neutral position. The C3-5 OCI, O-C2 angle, and OCD were analyzed in neutral, flexion, and extension position. The Kruskal–Wallis test was used to detect difference among four groups. The post hoc analysis was performed by Mann–Whitney U test.
Results
The cervical sagittal imbalance, cervical straight, and cervical kyphosis groups had significantly more lordosis angle in C3 and C4 OCI and O-C2 angle than the cervical lordosis group (p < 0.0125). Head motion in relation to C2, C3, and C4 (O-C2 angle, C3-4 OCI) in the kyphosis group was significantly greater than in the cervical lordosis group (p < 0.0125). The cervical sagittal imbalance group showed significantly increased O-C2 angle than the cervical lordosis group (p = 0.008). Regression analysis showed that an increase in O-C2 angle by one unit had a relative risk of 4.3% and 3.5% for a patient to be in the cervical sagittal imbalance and cervical kyphosis groups, respectively.
Conclusions
Cervical sagittal alignment affected craniocervical junction motion with the head exhibiting greater extension and motion in the cervical sagittal imbalance and cervical kyphosis groups. Motion of the head in relation to C2 can be used to predict the cervical sagittal alignment.
Similar content being viewed by others
References
Panjabi M, Dvorak J, Duranceau J, Yamamoto I, Gerber M, Rauschning W, Bueff HU (1988) Three-dimensional movements of the upper cervical spine. Spine (Phila Pa 1976) 13:726–730
Wolfla CE (2006) Anatomical, biomechanical, and practical considerations in posterior occipitocervical instrumentation. Spine J Offi J N Am Spine Soc 6:225S–232S. https://doi.org/10.1016/j.spinee.2006.09.001
Lopez AJ, Scheer JK, Leibl KE, Smith ZA, Dlouhy BJ, Dahdaleh NS (2015) Anatomy and biomechanics of the craniovertebral junction. Neurosurg Focus 38:E2. https://doi.org/10.3171/2015.1.FOCUS14807
Hayashi T, Daubs MD, Suzuki A, Scott TP, Phan K, Aghdasi B, Ruangchainikom M, Hu X, Lee C, Takahashi S, Shiba K, Wang JC (2016) The compensatory relationship of upper and subaxial cervical motion in the presence of cervical spondylosis. Clin Spine Surg 29:E196–200. https://doi.org/10.1097/BSD.0b013e3182aab240
Yoon SD, Lee CH, Lee J, Choi JY, Min WK (2017) Occipitocervical inclination: new radiographic parameter of neutral occipitocervical position. Eur Spine J. https://doi.org/10.1007/s00586-017-5161-0
Fineman S, Borrelli FJ, Rubinstein BM, Epstein H, Jacobson HG (1963) The cervical spine: transformation of the normal lordotic pattern into a linear pattern in the neutral posture. J Bone Joint Surg Am 45:1179–1183
Harrison DE, Harrison DD, Janik TJ, Holland B, Siskin LA (2001) Slight head extension: does it change the sagittal cervical curve? Eur Spine J 10:149–153
Anderst WJ, Donaldson WF, Lee JY, Kang JD (2013) Cervical spine intervertebral kinematics with respect to the head are different during flexion and extension motions. J Biomech 46:1471–1475. https://doi.org/10.1016/j.jbiomech.2013.03.004
Anderst WJ, Donaldson WF 3rd, Lee JY, Kang JD (2015) Cervical motion segment contributions to head motion during flexion\extension, lateral bending, and axial rotation. Spine J Off J N Am Spine Soc 15:2538–2543. https://doi.org/10.1016/j.spinee.2015.08.042
Miyazaki M, Hymanson HJ, Morishita Y, He W, Zhang H, Wu G, Kong MH, Tsumura H, Wang JC (2008) Kinematic analysis of the relationship between sagittal alignment and disc degeneration in the cervical spine. Spine (Phila Pa 1976) 33:E870–876. https://doi.org/10.1097/BRS.0b013e3181839733
Takeshima T, Omokawa S, Takaoka T, Araki M, Ueda Y, Takakura Y (2002) Sagittal alignment of cervical flexion and extension: lateral radiographic analysis. Spine (Phila Pa 1976) 27:E348–355
Yip CH, Chiu TT, Poon AT (2008) The relationship between head posture and severity and disability of patients with neck pain. Man Ther 13:148–154. https://doi.org/10.1016/j.math.2006.11.002
Patwardhan AG, Havey RM, Khayatzadeh S, Muriuki MG, Voronov LI, Carandang G, Nguyen NL, Ghanayem AJ, Schuit D, Patel AA, Smith ZA, Sears W (2015) Postural consequences of cervical sagittal imbalance: a Novel Laboratory Model. Spine (Phila Pa 1976) 40:783–792. https://doi.org/10.1097/BRS.0000000000000877
Weng C, Wang J, Tuchman A, Fu C, Hsieh PC, Buser Z, Wang JC (2016) Influence of T1 slope on the cervical sagittal balance in degenerative cervical spine: an analysis using kinematic MRI. Spine (Phila Pa 1976) 41:185–190. https://doi.org/10.1097/BRS.0000000000001353
Ames CP, Blondel B, Scheer JK, Schwab FJ, Le Huec JC, Massicotte EM, Patel AA, Traynelis VC, Kim HJ, Shaffrey CI, Smith JS, Lafage V (2013) Cervical radiographical alignment: comprehensive assessment techniques and potential importance in cervical myelopathy. Spine (Phila Pa 1976) 38:S149–160. https://doi.org/10.1097/BRS.0b013e3182a7f449
Sessumpun K, Paholpak P, Hindoyan KN, Tamai K, Sangkomkamhang T, Buser Z, Wang JC (2018) Characteristics of cervical spine motion in different types of cervical alignment: kinematic MRI study. Clin Spine Surg 31:E239–E244. https://doi.org/10.1097/BSD.0000000000000605
Suzuki A, Daubs MD, Inoue H, Hayashi T, Aghdasi B, Montgomery SR, Ruangchainikom M, Hu X, Lee CJ, Wang CJ, Wang BJ, Nakamura H (2013) Prevalence and motion characteristics of degenerative cervical spondylolisthesis in the symptomatic adult. Spine (Phila Pa 1976) 38:E1115–1120. https://doi.org/10.1097/BRS.0b013e31829b1487
Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174
Ruangchainikom M, Daubs MD, Suzuki A, Hayashi T, Weintraub G, Lee CJ, Inoue H, Tian H, Aghdasi B, Scott TP, Phan KH, Chotivichit A, Wang JC (2014) Effect of cervical kyphotic deformity type on the motion characteristics and dynamic spinal cord compression. Spine (Phila Pa 1976) 39:932–938. https://doi.org/10.1097/BRS.0000000000000330
Hansson EE, Beckman A, Hakansson A (2010) Effect of vision, proprioception, and the position of the vestibular organ on postural sway. Acta Otolaryngol 130:1358–1363. https://doi.org/10.3109/00016489.2010.498024
Cecchinato R, Langella F, Bassani R, Sansone V, Lamartina C, Berjano P (2014) Variations of cervical lordosis and head alignment after pedicle subtraction osteotomy surgery for sagittal imbalance. Eur Spine J 23(Suppl 6):644–649. https://doi.org/10.1007/s00586-014-3546-x
White AA 3rd, Panjabi MM (1978) The clinical biomechanics of the occipitoatlantoaxial complex. Orthop Clin North Am 9:867–878
Funding
No funds were received for this study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
There are not conflicts of interest, and disclosures outside of submitted work were provided in the Conflict of Interest forms. Disclosures outside of submitted work: JCW- Royalties – Biomet, Seaspine, Amedica, DePuy Synthes; Investments/Options – Bone Biologics, Pearldiver, Electrocore, Surgitech; Board of Directors - North American Spine Society, AO Foundation (20,000 honorariums for board position, plus travel for board meetings), Cervical Spine Research Society; Editorial Boards - Spine, The Spine Journal, Clinical Spine Surgery, Global Spine Journal; Fellowship Funding (paid directly to institution): AO Foundation; ZB- consultancy: Cerapedics, The Scripps Research Institute, Xenco Medical (past), AO Spine (past); Research Support: SeaSpine (past, paid to the institution), Next Science (paid directly to institution), Motion Metrix (paid directly to institution); North American Spine Society: committee member; Lumbar Spine Society: Co-chair Research committee, AOSpine Knowledge Forum Degenerative: Associate member; AOSNA Research committee- committee member.
Ethics approval
Institutional approval by University of Southern California.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Paholpak, P., Vega, A., Formanek, B. et al. Impact of cervical sagittal balance and cervical spine alignment on craniocervical junction motion: an analysis using upright multi-positional MRI. Eur Spine J 30, 444–453 (2021). https://doi.org/10.1007/s00586-020-06559-5
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-020-06559-5