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Sagittal balance of the cervical spine: a systematic review and meta-analysis

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Abstract

Purpose

The purpose of this systematic review and meta-analysis was to compare the cervical sagittal parameters between patients with cervical spine disorder and asymptomatic controls.

Methods

Two independent authors systematically searched online databases including Pubmed, Scopus, Cochrane library, and Web of Science up to June 2020. Cervical sagittal balance parameters, such as T1 slope, cervical SVA (cSVA), and spine cranial angle (SCA), were compared between the cervical spine in healthy, symptomatic, and pre-operative participants. Where possible, we pooled data using random-effects meta-analysis, by CMA software. Heterogeneity and publication bias were assessed using the I-squared statistic and funnel plots, respectively.

Results

A total of 102 studies, comprising 13,802 cases (52.7% female), were included in this meta-analysis. We used the Newcastle–Ottawa Scale (NOS) to evaluate the quality of studies included in this review. Funnel plot and Begg’s test did not indicate obvious publication bias. The pooled analysis reveals that the mean (SD) values were: T1 slope (degree), 24.5 (0.98), 25.7 (0.99), 25.4 (0.34); cSVA (mm), 18.7 (1.76), 22.7 (0.66), 22.4 (0.68) for healthy population, symptomatic, and pre-operative assessment, respectively. The mean value of the SCA (degree) was 79.5 (3.55) and 75.6 (10.3) for healthy and symptomatic groups, respectively. Statistical differences were observed between the groups (all P values < 0.001).

Conclusion

The findings showed that the T1 slope and the cSVA were significantly lower among patients with cervical spine disorder compared to controls and higher for the SCA. Further well-conducted studies are needed to complement our findings.

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Abbreviations

NOS:

Newcastle–Ottawa Scale

CMA:

Comprehensive Meta-Analysis Software

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Authors and Affiliations

  1. Neuroscience Research Center, Shahid Beheshti University of Medical Sciences, Arabi Ave, Daneshjoo Blvd, Velenjak, 19839-63113, Tehran, Iran

    Parisa Azimi

  2. School of Medicine, Capital Medical University, Beijing, China

    Taravat Yazdanian

  3. Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, OH, USA

    Edward C. Benzel

  4. Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China

    Yong Hai

  5. Mental Health Research Group, Health Metrics Research Centre, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran

    Ali Montazeri

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Azimi, P., Yazdanian, T., Benzel, E.C. et al. Sagittal balance of the cervical spine: a systematic review and meta-analysis. Eur Spine J 30, 1411–1439 (2021). https://doi.org/10.1007/s00586-021-06825-0

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