Skip to main content
SpringerLink
Log in

Cervical and postural strategies for maintaining horizontal gaze in asymptomatic adults

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

To investigate the different cervical strategies for maintaining horizontal gaze in asymptomatic subjects.

Methods

One hundred and forty-four asymptomatic adults filled the SF-36 quality of life questionnaire and underwent full-body biplanar radiographs. Chin brow vertical angle (CBVA) and postural and cervical parameters were measured. Subjects were grouped according to cervical spine curvature (C2–C7 angle): kyphotic (< − 5°), straight [− 5°, 5°], lordotic (> 5°). Demographics, SF-36 component scores and CBVA were compared between groups. All other parameters were compared between groups, while controlling for confounding factors (ANCOVA). A correlation test was conducted between all cervical parameters.

Results

32% of subjects had kyphotic (− 12° ± 7°), 27% straight (0° ± 3°) and 41% lordotic (12° ± 7°) cervical spines. While demographic and SF-36 data did not differ between groups, CBVA differed between lordotic and kyphotic groups (2° vs. 6.5°, p = 0.002). Sagittal vertical axis (SVA) and thoracic kyphosis (TK) were lower in the kyphotic group (SVA: K = − 26 ± 20 mm vs. L = − 2 ± 21 mm, p < 0.001; TK: K = 40° ± 6° vs. L = 51° ± 8°, p < 0.001). C2 slope (K = 29° ± 6° vs. L = 18° ± 6°, p < 0.001), C0–C2 (K = 42° ± 8° vs. L = 30° ± 8°, p < 0.001) and C1–C2 (K = 33° ± 6° vs. L = 28° ± 6°, p = 0.004) were higher in the kyphotic group. Significant correlations were found between almost all cervical parameters and C2–C7 angle.

Conclusions

Subjects with cervical kyphosis presented with more posterior global alignment and lower TK than subjects with lordosis. In order to maintain horizontal gaze, subjects with cervical kyphosis presented with a more lordotic upper cervical spine than subjects with cervical lordosis. Subjects with straight cervical curvature presented with an intermediate sagittal alignment.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Sparrey CJ, Bailey JF, Safaee M et al (2014) Etiology of lumbar lordosis and its pathophysiology: a review of the evolution of lumbar lordosis, and the mechanics and biology of lumbar degeneration. Neurosurg Focus 36:E1. https://doi.org/10.3171/2014.1.FOCUS13551

    Article  PubMed  Google Scholar 

  2. Vialle R, Levassor N, Rillardon L et al (2005) Radiographic analysis of the sagittal alignment and balance of the spine in asymptomatic subjects. J Bone Joint Surg Am 87:260–267. https://doi.org/10.2106/JBJS.D.02043

    Article  PubMed  Google Scholar 

  3. Roussouly P, Gollogly S, Berthonnaud E, Dimnet J (2005) Classification of the Normal Variation in the Sagittal Alignment of the Human Lumbar Spine and Pelvis in the Standing Position. Spine (Phila Pa 1976) 30:346–353

    Article  Google Scholar 

  4. Mac-Thiong J-M, Roussouly P, Berthonnaud E, Guigui P (2010) Sagittal parameters of global spinal balance: normative values from a prospective cohort of seven hundred nine Caucasian asymptomatic adults. Spine (Phila Pa 1976) 35:E1193–E1198. https://doi.org/10.1097/brs.0b013e3181e50808

    Article  Google Scholar 

  5. Endo K, Suzuki H, Nishimura H et al (2014) Characteristics of sagittal spino-pelvic alignment in Japanese young adults. Asian Spine J 8:599–604. https://doi.org/10.4184/asj.2014.8.5.599

    Article  PubMed  PubMed Central  Google Scholar 

  6. Roussouly P, Pinheiro-Franco JL (2011) Biomechanical analysis of the spino-pelvic organization and adaptation in pathology. Eur Spine J 20:1–10. https://doi.org/10.1007/s00586-011-1928-x

    Article  Google Scholar 

  7. Hasegawa K, Okamoto M, Hatsushikano S et al (2016) Normative values of spino-pelvic sagittal alignment, balance, age, and health-related quality of life in a cohort of healthy adult subjects. Eur Spine J 25:2–5. https://doi.org/10.1007/s00586-016-4702-2

    Article  Google Scholar 

  8. Amabile C, Pillet H, Lafage V et al (2016) A new quasi-invariant parameter characterizing the postural alignment of young asymptomatic adults. Eur Spine J. https://doi.org/10.1007/s00586-016-4552-y

    Article  PubMed  Google Scholar 

  9. Scheer JK, Tang JA, Smith JS et al (2013) Cervical spine alignment, sagittal deformity, and clinical implications: a review. J Neurosurg Spine 19:141–159. https://doi.org/10.3171/2013.4.SPINE12838

    Article  PubMed  Google Scholar 

  10. Lafage R, Challier V, Liabaud B et al (2015) Natural head posture in the setting of sagittal spinal deformity: validation of Chin-Brow vertical angle, slope of line of sight, and McGregorʼs slope with health-related quality of life. Neurosurgery. https://doi.org/10.1227/NEU.0000000000001193

    Article  PubMed  Google Scholar 

  11. Suk KS, Kim KT, Lee SH, Kim JM (2003) Significance of chin-brow vertical angle in correction of kyphotic deformity of ankylosing spondylitis patients. Spine (Phila Pa 1976) 28:2001–2005. https://doi.org/10.1097/01.brs.0000083239.06023.78

    Article  Google Scholar 

  12. Diebo BG, Challier V, Henry JK et al (2016) Predicting cervical alignment required to maintain horizontal gaze based on global spinal alignment. Spine (Phila Pa 1976) 41:1795–1800. https://doi.org/10.1097/brs.0000000000001698

    Article  Google Scholar 

  13. Roussouly P, Pinheiro-Franco JL (2011) Sagittal parameters of the spine: biomechanical approach. Eur Spine J 20:1–8. https://doi.org/10.1007/s00586-011-1924-1

    Article  Google Scholar 

  14. Le Huec JC, Demezon H, Aunoble S (2015) Sagittal parameters of global cervical balance using EOS imaging: normative values from a prospective cohort of asymptomatic volunteers. Eur Spine J 24:63–71. https://doi.org/10.1007/s00586-014-3632-0

    Article  PubMed  Google Scholar 

  15. Yukawa Y, Kato F, Suda K et al (2012) Age-related changes in osseous anatomy, alignment, and range of motion of the cervical spine. Part I: radiographic data from over 1,200 asymptomatic subjects. Eur Spine J 21:1492–1498. https://doi.org/10.1007/s00586-012-2167-5

    Article  PubMed  PubMed Central  Google Scholar 

  16. Sabbah I, Drouby N, Sabbah S et al (2003) Quality of life in rural and urban populations in Lebanon using SF-36 health survey. Heal Qual Life Outcomes 1:30.

    Article  Google Scholar 

  17. Faro FD, Marks MC, Pawelek J, Newton PO (2004) Evaluation of a functional position for lateral radiograph acquisition in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 29:2284–2289. https://doi.org/10.1097/01.brs.0000142224.46796.a7

    Article  Google Scholar 

  18. Lee S, Kim K, Seo E et al (2012) The influence of thoracic inlet alignment on the craniocervical sagittal balance in asymptomatic adults. J spinal Disord Tech 25:E41–E47. https://doi.org/10.1097/BSD.0b013e3182396301

    Article  PubMed  Google Scholar 

  19. Janusz P, Tyrakowski M, Yu H, Siemionow K (2016) Reliability of cervical lordosis measurement techniques on long-cassette radiographs. Eur spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 25:3596–3601. https://doi.org/10.1007/s00586-015-4345-8

    Article  Google Scholar 

  20. Singer KP, Jones TJ, Breidahl PD (1990) A comparison of radiographic and computer-assisted measurements of thoracic and thoracolumbar sagittal curvature. Skeletal Radiol. https://doi.org/10.1007/BF00197923

    Article  PubMed  Google Scholar 

  21. Obeid I, Boniello A, Boissiere L et al (2015) Cervical spine alignment following lumbar pedicle subtraction osteotomy for sagittal imbalance. Eur Spine J 24:1191–1198. https://doi.org/10.1007/s00586-014-3738-4

    Article  PubMed  Google Scholar 

  22. Ames CP, Blondel B, Scheerr JK et al (2013) Cervical radiographic alignment : comprehensive assessment techniques and potential importance in cervical myelopathy. Spine (Phila Pa 1976) 38:149–160. https://doi.org/10.1097/brs.0b013e3182a7f449

    Article  Google Scholar 

  23. Bakouny Z, Assi A, Yared F et al (2017) Normative spino-pelvic sagittal alignment of lebanese asymptomatic adults: comparisons with different ethnicities. Orthop Traumatol Surg Res. https://doi.org/10.1016/j.otsr.2017.11.017

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. This study has received funding by the research council of the University of Saint-Joseph (Grant No. FM189). The sponsors had no involvement in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. No complex statistical methods were necessary for this paper. Institutional review board approval was obtained.

Funding

This study was funded by the University of Saint-Joseph (grant number FM189).

Author information

Authors and Affiliations

  1. Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon

    Nour Khalil, Aren Joe Bizdikian, Ziad Bakouny, Michel Salameh, Naji Bou Zeid, Fares Yared, Joeffroy Otayek, Khalil Kharrat, Gaby Kreichati, Ismat Ghanem & Ayman Assi

  2. Spine Division, Hospital for Special Surgery, New York, USA

    Renaud Lafage & Virginie Lafage

  3. Bordeaux University Hospital, Bordeaux, France

    Ibrahim Obeid

Authors
  1. Nour Khalil
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aren Joe Bizdikian
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ziad Bakouny
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michel Salameh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Naji Bou Zeid
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Fares Yared
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Joeffroy Otayek
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Khalil Kharrat
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Gaby Kreichati
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Ismat Ghanem
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Renaud Lafage
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Virginie Lafage
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Ibrahim Obeid
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Ayman Assi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ayman Assi.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PPTX 1670 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Khalil, N., Bizdikian, A.J., Bakouny, Z. et al. Cervical and postural strategies for maintaining horizontal gaze in asymptomatic adults. Eur Spine J 27, 2700–2709 (2018). https://doi.org/10.1007/s00586-018-5753-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-018-5753-3

Keywords

Search

Navigation