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MRI kinematic analysis of T1 sagittal motion between cervical flexion and extension positions in 145 patients

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Abstract

Purpose

Although the T1 vertebra is considered as an important factor of cervical balance, little is known about its motion between flexion and extension. The purpose of present study was to analyze the T1 sagittal motion using kinematic magnetic resonance imaging (kMRI), and to identify factors that relate to T1 sagittal motion.

Methods

We retrospectively analyzed 145 kMR images taken in weight-bearing neutral, flexion and extension positions. Cervical balance parameters were evaluated in each position. The degree of T1 sagittal motion was defined as [(T1 slope at extension) − (T1 slope at flexion)]. All patients were divided into three groups: Positive group (T1 followed the head motion, T1 sagittal motion > 5°), Stable group (5 ≥, ≥ − 5) and Negative group (T1 moved in the opposite direction from the head motion, > − 5). The groups were compared and multivariate logistic regression analysis was calculated.

Results

There were 57 (40%) patients in the positive, 56 (39%) in the stable and 32 (22%) in the negative group. The positive group had the largest C2–7 sagittal vertical axis in flexion (p < 0.001) and the shortest in the extension (p = 0.023). Similar trends were seen in cranial tilt and cervical tilt. The value of T1 height < 27 mm was a significant independent factor for the negative group (p = 0.008, adjusted odds ratio = 5.958).

Conclusion

Based on T1 sagittal motion, 40% of the patients were classified in positive group (the T1 vertebra followed the head motion in flexion and extension), and 20% were classified in the negative group (the T1 vertebra moved in the opposite direction from the head motion). T1 height < 27 mm was a potential predictor of negative group.

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Acknowledgements

The study was supported by departmental funds. The authors would like to thank AiM Radiology Medical Group, especially to Yusuf A. Khan, Sameer U. Khan and Aziza Qadir MD for their help on obtaining and uploading kMRI images into the database.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1450 Biggy Street, NRT-4513, Los Angeles, CA, 90033, USA

    Koji Tamai, Zorica Buser, Permsak Paholpak, Kittipong Sessumpun & Jeffrey C. Wang

  2. Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, USA

    Patrick C. Hsieh

  3. Department of Orthopedics, Graduate School of Medicine, Osaka City University, Osaka, Japan

    Koji Tamai & Hiroaki Nakamura

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  1. Koji Tamai
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  2. Zorica Buser
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Correspondence to Zorica Buser.

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Conflict of interest

There are no conflicts of interest for the current study.

Disclosures outside of submitted work

ZB-Xenco Medical (consultancy), AO Spine (consultancy, past); PCH-Consulting: DePuy Synthes, Medtronic, NuVasive, Zimmer Biomet; JCW—Royalties: Aesculap, Biomet, Amedica, Seaspine, Synthes; Stock Ownership: Fziomed; Private Investments: Promethean Spine, Paradigm spine, Benevenue, NexGen, Vertiflex, electrocore, surgitech, expanding orthopaedics, osprey, bone biologics, curative biosciences, pearldiver; Board of Directors: North American Spine Society (Second Vice President), North American Spine Foundation (non-financial), Cervical Spine Research Society (Travel expenses), AO Spine/AO Foundation (honorariums for board position); Fellowship Support: AO Foundation (spine fellowship funding paid to institution).

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No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

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Tamai, K., Buser, Z., Paholpak, P. et al. MRI kinematic analysis of T1 sagittal motion between cervical flexion and extension positions in 145 patients. Eur Spine J 27, 1034–1041 (2018). https://doi.org/10.1007/s00586-017-5385-z

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  • DOI: https://doi.org/10.1007/s00586-017-5385-z

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