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Variation of cervical sagittal alignment parameters according to gender, pelvic incidence and age

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A Correction to this article was published on 17 March 2022

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Abstract

Purpose

The aim was to describe radiographic cervical sagittal alignment variations according to age, gender and pelvic incidence (PI) and to investigate relationships with thoracic alignment.

Methods

A total of 2599 individuals (5–93 years) without spinal deformity were studied. Cranial cervical parameters were: McGregor slope, occipita-C2 angle, McGregor-C2 lordosis and C1–C2 lordosis. Caudal cervical parameters were: C2–C7, cranial arch and caudal arch lordosis and C7- and T1-slope. A Bayesian inference compared parameter distributions. Correlations with spinopelvic and global alignment parameters were investigated.

Results

Among cranial cervical parameters, variations of McGregor slope were non-significant. McGregor-C2 lordosis and C1–C2 lordosis were smaller in males and increased significantly during growth, whereas the occipito-C2 angle decreased (Pr > 0.95). The occipito-C2 angle was larger and McGregor-C2 lordosis was smaller in low PI (Pr > 0.95). Among caudal cervical parameters, C2–C7 lordosis and C7- and T1-slope were larger in males and increased after 50 years (Pr > 0.95). Lordosis changes were non-significant in the cranial arch, whereas values increased in the caudal arch after 35 years (Pr > 0.95). Caudal parameter differences were non-significant between PI groups. Strong correlations existed between C2–C7, caudal arch lordosis, C7-slope, T1-slope and thoracic kyphosis. The sagittal vertical axis C2 correlated with caudal arch lordosis and T1-slope (ρ > 0.5; Pr > 0.95).

Conclusion

Cervical alignment parameters vary according to age, gender and PI. In the cranial cervical spine, changes occur mainly during growth. In the caudal cervical spine, lordosis increases in the caudal arch, which is related to thoracic kyphosis increase with age. The caudal cervical arch acts as a compensatory segment by progressive extension, allowing horizontal gaze.

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Acknowledgements

The authors would like to thank Philippe Roussouly for technical support using the KEOPS online database.

Funding

The KEOPS online database license was funded by the French Spine Surgery Society (SFCR). All the authors participated in the study with no study funding involved.

Author information

Authors and Affiliations

  1. Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, 1 Avenue Molière, 67200, Strasbourg, France

    Yann Philippe Charles

  2. Unité de Chirurgie Rachidienne, CHU Timone, Aix-Marseille Université, Marseille, France

    Solène Prost & Benjamin Blondel

  3. Service d’Orthopédie Pédiatrique, CHU Timone, Aix-Marseille Université, Marseille, France

    Sébastien Pesenti

  4. Service de Chirurgie Orthopédique Pédiatrique, AP-HP, CHU Robert Debré, Université de Paris, Paris, France

    Brice Ilharreborde & Matthieu Campana

  5. Service de Chirurgie Orthopédique et Traumatologie, Hôpital Maison Blanche, CHU de Reims, Reims, France

    Eloïse Bauduin

  6. Hôpital Privé de L’Est Lyonnais, Saint-Priest, France

    Féthi Laouissat

  7. Service de Chirurgie Orthopédique et Traumatolgique, Groupe Hospitalier Paris Saint Joseph, Paris, France

    Guillaume Riouallon & Stéphane Wolff

  8. Hôpital Privé du Dos Francheville, Périgueux, France

    Vincent Challier

  9. Clinique du Dos Jean Villar, Bruges, France

    Ibrahim Obeid & Louis Boissière

  10. Service de Chirurgie Orthopédique de la Colonne Vertébrale, AP-HP, Hôpital Européen Georges-Pompidou, Université de Paris, Paris, France

    Emmanuelle Ferrero

  11. Service d’Orthopédie Pédiatrique, Fondation Lenval, Nice, France

    Federico Solla

  12. Polyclinique Bordeaux Nord Aquitaine, Université de Bordeaux, Bordeaux, France

    Jean-Charles Le Huec & Stéphane Bourret

  13. Institut de la Colonne Vertébrale et des Neurosciences, Centre Médico-Chirurgical Bizet, Paris, France

    Joe Faddoul & Georges Naïm Abi Lahoud

  14. Centre Orthopédique Santy, Unité du Rachis, Lyon, France

    Vincent Fière & Michiel Vande Kerckhove

  15. Institut Locomoteur de L’Ouest Rachis, Centre Hospitalier Privé Saint-Grégoire, Saint-Grégoire, France

    Jonathan Lebhar

  16. Institut Méditerranéen du Dos, Marseille, France

    Hadrien Giorgi & Aymeric Faure

  17. Pôle Santé Publique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France

    Erik André Sauleau

Authors
  1. Yann Philippe Charles
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  2. Solène Prost
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  3. Sébastien Pesenti
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  4. Brice Ilharreborde
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  12. Emmanuelle Ferrero
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  13. Federico Solla
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  14. Jean-Charles Le Huec
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  16. Joe Faddoul
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  17. Georges Naïm Abi Lahoud
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  18. Vincent Fière
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  19. Michiel Vande Kerckhove
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  20. Matthieu Campana
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  21. Jonathan Lebhar
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  22. Hadrien Giorgi
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  23. Aymeric Faure
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  24. Erik André Sauleau
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  25. Benjamin Blondel
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Consortia

The French Spine Surgery Society (SFCR)

Contributions

Yann Philippe Charles designed and coordinated the study, collected and analyzed data and wrote the manuscript. Benjamin Blondel, Solène Prost, Sébastien Pesenti, Brice Ilharreborde, Eloïse Bauduin and Féthi Laouissat designed the study, collected and analyzed data and approved the manuscript. Erik André Sauleau designed the study, analyzed data and approved the manuscript. Guillaume Riouallon, Stéphane Wolff, Vincent Challier, Ibrahim Obeid, Louis Boissière, Emmanuelle Ferrero, Federico Solla, Jean-Charles Le Huec, Stéphane Bourret, Joe Faddoul, Georges Naïm Abi Lahoud, Vincent Fière, Michiel Vande Kerckhove, Matthieu Campana, Jonathan Lebhar, Hadrien Giorgi and Aymeric Faure collected and analyzed data and approved the manuscript.

Corresponding author

Correspondence to Yann Philippe Charles.

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Conflict of interest

Yann Philippe Charles is consultant for Stryker, Clariance, Philips and Ceraver; he received royalties and grants unrelated to this study from Stryker and Clariance. Brice Ilharreborde is consultant for Zimmer Biomet, Medtronic and Implanet. Féthi Laouissat is consultant for Spineart and SMAIO. Guillaume Riouallon is consultant for Medtronic, Stryker and NewClip; he received royalties from Euros. Vincent Challier is shareholder of Follow Health SA and consultant for Clariance. Ibrahim Obeid is consultant for Medtronic and DePuy Synthes; he received grants from DePuy Synthes unrelated to this study and royalties from Clariance, Alphatec and Spineart. Louis Boissière is consultant for Neo and Euros; he received grants from DePuy Synthes unrelated to this study. Federico Solla received funding to attend meetings from Medicrea, Medtronic and Euros. Jean-Charles Le Huec is consultant for Medtronic and BD Bard; he received royalties and grants unrelated to this study from Medtronic. Vincent Fière is consultant for Clariance; he received royalties Medicrea and Clariance. Aymeric Faure is consultant for OSD. Benjamin Blondel is associate editor for OTSR Elsevier-Masson and consultant for Medicrea, Medtronic, Implanet, Vexim Stryker and M. Solène Prost, Sébastien Pesenti, Eloïse Bauduin, Stéphane Wolff, Emmanuelle Ferrero, Stéphane Bourret, Joe Faddoul, Georges Naïm Abi Lahoud, Michiel Vande Kerckhove, Matthieu Campana, Jonathan Lebhar, Hadrien Giorgi and Erik André Sauleau have no conflict of interest.

Ethics approval

Institutional review board approval (FC/2019-91) was obtained. The study was declared at ClinicalTrials.gov ID: NCT04467775.

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Informed consent was obtained from study participants.

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Informed consent for publication of results was obtained from study participants.

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Charles, Y.P., Prost, S., Pesenti, S. et al. Variation of cervical sagittal alignment parameters according to gender, pelvic incidence and age. Eur Spine J 31, 1228–1240 (2022). https://doi.org/10.1007/s00586-021-07102-w

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