Skip to main content

Cervical Alignment and Sagittal Balance

  • Chapter
  • First Online:
Degenerative Cervical Myelopathy and Radiculopathy

Abstract

In patients with cervical spine pathologies, surgical consideration of alignment and balance is critical for obtaining optimal outcomes [1]. Preoperative evaluation of these patients must therefore take into account baseline deformity, as well as potential risk of progression. As such, reliable methods of describing cervical alignment and balance and awareness of their surgical implications are of the utmost importance. Here, we describe standard parameters utilized in classification of cervical spine alignment, deformity, and their key clinical associations.

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

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Hann S, et al. An algorithmic strategy for selecting a surgical approach in cervical deformity correction. Neurosurg Focus. 2014;36(5):E5.

    Article  Google Scholar 

  2. Scheer JK, et al. Cervical spine alignment, sagittal deformity, and clinical implications: a review. J Neurosurg Spine. 2013;19(2):141–59.

    Article  Google Scholar 

  3. Kuntz CT, et al. Neutral upright sagittal spinal alignment from the occiput to the pelvis in asymptomatic adults: a review and resynthesis of the literature. J Neurosurg Spine. 2007;6(2):104–12.

    Article  Google Scholar 

  4. Ames CP, et al. Cervical radiographical alignment: comprehensive assessment techniques and potential importance in cervical myelopathy. Spine (Phila Pa 1976). 2013;38(22 Suppl 1):S149–60.

    Article  Google Scholar 

  5. Ames CP, et al. A standardized nomenclature for cervical spine soft-tissue release and osteotomy for deformity correction: clinical article. J Neurosurg Spine. 2013;19(3):269–78.

    Article  Google Scholar 

  6. Hardacker JW, et al. Radiographic standing cervical segmental alignment in adult volunteers without neck symptoms. Spine (Phila Pa 1976). 1997;22(13):1472–1480; discussion 1480.

    Google Scholar 

  7. Grob D, et al. The association between cervical spine curvature and neck pain. Eur Spine J. 2007;16(5):669–78.

    Article  CAS  Google Scholar 

  8. Le Huec JC, et al. Sagittal parameters of global cervical balance using EOS imaging: normative values from a prospective cohort of asymptomatic volunteers. Eur Spine J. 2015;24(1):63–71.

    Article  Google Scholar 

  9. Shimizu K, et al. Spinal kyphosis causes demyelination and neuronal loss in the spinal cord: a new model of kyphotic deformity using juvenile Japanese small game fowls. Spine (Phila Pa 1976). 2005;30(21):2388–92.

    Article  Google Scholar 

  10. Jarzem PF, et al. Spinal cord tissue pressure during spinal cord distraction in dogs. Spine (Phila Pa 1976). 1992;17(8 Suppl):S227–34.

    Article  CAS  Google Scholar 

  11. Oshima Y, Seichi A, Takeshita K, Chikuda H, Ono T, Baba S, Morii J, Oka H, Kawaguchi H, Nakamura K, Tanaka S. Natural course and prognostic factors in patients with mild cervical spondylotic myelopathy with increased signal intensity on T2-weighted magnetic resonance imaging. Spine (Phila Pa 1976). 2012;37(22):1909–13.

    Article  Google Scholar 

  12. Shamji MF, et al. The Association of Cervical Spine Alignment with neurologic recovery in a prospective cohort of patients with surgical myelopathy: analysis of a series of 124 cases. World Neurosurg. 2016;86:112–9.

    Article  Google Scholar 

  13. Guerin P, et al. Sagittal alignment after single cervical disc arthroplasty. J Spinal Disord Tech. 2012;25(1):10–6.

    Article  Google Scholar 

  14. Kim KT, et al. Surgical treatment of “chin-on-pubis” deformity in a patient with ankylosing spondylitis: a case report of consecutive cervical, thoracic, and lumbar corrective osteotomies. Spine (Phila Pa 1976). 2012;37(16):E1017–21.

    Article  Google Scholar 

  15. Suk KS, et al. Significance of chin-brow vertical angle in correction of kyphotic deformity of ankylosing spondylitis patients. Spine (Phila Pa 1976). 2003;28(17):2001–5.

    Article  Google Scholar 

  16. Lafage R, et al. Natural head posture in the setting of sagittal spinal deformity: validation of chin-brow vertical angle, slope of line of sight, and McGregor's slope with health-related quality of life. Neurosurgery. 2016;79(1):108–15.

    Article  Google Scholar 

  17. Deviren V, Scheer JK, Ames CP. Technique of cervicothoracic junction pedicle subtraction osteotomy for cervical sagittal imbalance: report of 11 cases. J Neurosurg Spine. 2011;15(2):174–81.

    Article  Google Scholar 

  18. Miyata M, et al. O-C2 angle as a predictor of dyspnea and/or dysphagia after occipitocervical fusion. Spine (Phila Pa 1976). 2009;34(2):184–8.

    Article  Google Scholar 

  19. Morishima N, et al. The influences of halo-vest fixation and cervical hyperextension on swallowing in healthy volunteers. Spine (Phila Pa 1976). 2005;30(7):E179–82.

    Article  Google Scholar 

  20. Yoshida M, et al. Upper-airway obstruction after short posterior occipitocervical fusion in a flexed position. Spine (Phila Pa 1976). 2007;32(8):E267–70.

    Article  Google Scholar 

  21. Garfin SR, Botte MJ, Waters RL, Nickel VL. Complications in the use of the halo fixation device. J Bone Joint Surg Am. 1986;68(3):320–5.

    Article  CAS  Google Scholar 

  22. Izeki M, et al. Reduction of atlantoaxial subluxation causes airway stenosis. Spine (Phila Pa 1976). 2013;38(9):E513–20.

    Article  Google Scholar 

  23. Kaneyama S, et al. Dysphagia after Occipitothoracic fusion is caused by direct compression of oropharyngeal space due to anterior protrusion of mid-cervical spine. Clin Spine Surg. 2017;30(7):314–20.

    Article  Google Scholar 

  24. Kaneyama S, et al. The prediction and prevention of dysphagia after Occipitospinal fusion by use of the S-line (swallowing line). Spine (Phila Pa 1976). 2017;42(10):718–25.

    Article  Google Scholar 

  25. Bagley CA, et al. Assuring optimal physiologic craniocervical alignment and avoidance of swallowing-related complications after occipitocervical fusion by preoperative halo vest placement. J Spinal Disord Tech. 2009;22(3):170–6.

    Article  Google Scholar 

  26. Matsuyama Y, et al. Long-term results of occipitothoracic fusion surgery in RA patients with destruction of the cervical spine. J Spinal Disord Tech. 2005;18(Suppl):S101–6.

    Article  Google Scholar 

  27. Iyer S, et al. Impact of cervical sagittal alignment parameters on neck disability. Spine (Phila Pa 1976). 2016;41(5):371–7.

    Article  Google Scholar 

  28. Smith JS, et al. Association of myelopathy scores with cervical sagittal balance and normalized spinal cord volume: analysis of 56 preoperative cases from the AOSpine North America myelopathy study. Spine (Phila Pa 1976). 2013;38(22 Suppl 1):S161–70.

    Article  Google Scholar 

  29. Tang JA, et al. The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery. Neurosurgery. 2012;71(3):662–669; discussion 669.

    Article  Google Scholar 

  30. Hyun SJ, et al. Relationship between T1 slope and cervical alignment following multilevel posterior cervical fusion surgery: impact of T1 slope minus cervical lordosis. Spine (Phila Pa 1976). 2016;41(7):E396–402.

    Article  Google Scholar 

  31. Lee JS, et al. Relationship between cervical sagittal alignment and quality of life in ankylosing spondylitis. Eur Spine J. 2015;24(6):1199–203.

    Article  Google Scholar 

  32. Kim TH, et al. T1 slope as a predictor of kyphotic alignment change after laminoplasty in patients with cervical myelopathy. Spine (Phila Pa 1976). 2013;38(16):E992–7.

    Article  Google Scholar 

  33. Weng C, et al. Influence of T1 slope on the cervical sagittal balance in degenerative cervical spine: an analysis using kinematic MRI. Spine (Phila Pa 1976). 2016;41(3):185–90.

    Article  Google Scholar 

  34. Protopsaltis TS. et al. T1 slope minus cervical lordosis (TS-CL), the cervical analog of PI-LL defines cervical sagittal deformity in patients undergoing thoracolumbar osteotomy. Abstract presented at the 2013 Annual meeting of the Cervical Spine Research Society in Los Angeles; 2013.

    Google Scholar 

  35. Smith JS, et al. Prevalence and type of cervical deformity among 470 adults with thoracolumbar deformity. Spine (Phila Pa 1976). 2014;39(17):E1001–9.

    Article  Google Scholar 

  36. Oh T, et al. Cervical compensatory alignment changes following correction of adult thoracic deformity: a multicenter experience in 57 patients with a 2-year follow-up. J Neurosurg Spine. 2015;22(6):658–65.

    Article  Google Scholar 

  37. Smith JS, et al. Spontaneous improvement of cervical alignment after correction of global sagittal balance following pedicle subtraction osteotomy. J Neurosurg Spine. 2012;17(4):300–7.

    Article  Google Scholar 

  38. Knott PT, et al. The use of the T1 sagittal angle in predicting overall sagittal balance of the spine. Spine J. 2010;10(11):994–8.

    Article  Google Scholar 

  39. Klineberg EO, et al. Can measurements on cervical radiographs predict concurrent thoracolumbar deformity and provide a threshold for acquiring full-length spine radiographs? Spine J. 2015;15(10):S146.

    Article  Google Scholar 

  40. Ghobrial GM, et al. Changes in cervical alignment after multilevel Schwab grade II thoracolumbar osteotomies for adult spinal deformity. Spine (Phila Pa 1976). 2018;43(2):E82–91.

    Article  Google Scholar 

  41. Ames CP, et al. Reliability assessment of a novel cervical spine deformity classification system. J Neurosurg Spine. 2015;23(6):673–83.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Alexander Tuchman .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Tuchman, A., Higgins, D.M.O. (2019). Cervical Alignment and Sagittal Balance. In: Kaiser, M., Haid, R., Shaffrey, C., Fehlings, M. (eds) Degenerative Cervical Myelopathy and Radiculopathy . Springer, Cham. https://doi.org/10.1007/978-3-319-97952-6_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-97952-6_3

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-97951-9

  • Online ISBN: 978-3-319-97952-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics