基于整体脊柱排列预测维持水平注视所需的颈椎排列。
Predicting Cervical Alignment Required to Maintain Horizontal Gaze Based on Global Spinal Alignment.
作者信息
Diebo Bassel G, Challier Vincent, Henry Jensen K, Oren Jonathan H, Spiegel Matthew Adam, Vira Shaleen, Tanzi Elizabeth M, Liabaud Barthelemy, Lafage Renaud, Protopsaltis Themistocles S, Errico Thomas J, Schwab Frank J, Lafage Virginie
机构信息
Spine Service, Hospital for Special Surgery, New York, NY.
Spine Unit 1, Orthopedic Surgery Department, Bordeaux University Hospital, Bordeaux, France.
出版信息
Spine (Phila Pa 1976). 2016 Dec 1;41(23):1795-1800. doi: 10.1097/BRS.0000000000001698.
STUDY DESIGN
A retrospective cohort.
OBJECTIVE
The aim of this study was to investigate the cervical alignment necessary for the maintenance of horizontal gaze that depends on underlying thoracolumbar alignment.
SUMMARY OF BACKGROUND DATA
Cervical Sagittal Curve (CC) is affected by thoracic and global alignment. Recent studies suggest large variability in normative CC ranging from lordotic to kyphotic alignment. No previous studies have assessed the effect of global spinal alignment on CC in maintenance of horizontal gaze.
METHODS
Patients without previous history of spinal surgery and able to maintain their horizontal gaze while undergoing full body imaging were included. Patients were stratified on the basis of thoracic kyphosis (TK) into (<30, 30-40, 40-50, and >50) and then by SRS-Schwab sagittal vertical axis (SVA) modifier into (posterior alignment SVA <0, aligned 0-50, and malaligned >50 mm). Cervical alignment was assessed among SVA grade in TK groups. Stepwise linear regression analysis was applied on random selection of 60% of the population. A simplified formula was developed and validated on the remaining 40%.
RESULTS
In each TK group (n = 118, 137, 125, 197), lower CC (C2-C7) was significantly more lordotic by increased Schwab SVA grade. T1 slope and cervical SVA significantly increased with increased thoracolumbar (C7-S1) SVA. Upper CC (C0-C2) and mismatch between T1 slope and CC (T1-CL) were similar. Regression analysis revealed LL minus TK (LL-TK) as an independent predictor (r = 0.640, r = 0.410) with formula: CC = 10- (LL-TK)/2. Validation revealed that the absolute difference between the predicted CC and the actual CC was 8.5°. Moreover, 64.2% of patients had their predicted C2-C7 values within 10° of the actual CC.
CONCLUSION
Cervical kyphosis may represent normal alignment in a significant number of patients. However, in patients with SVA >50 and greater thoracic kyphosis, cervical lordosis is needed to maintain the gaze. Cervical alignment can be predicted from underlying TK and lumbar lordosis, which may be clinically relevant when considering correction for thoracolumbar or cervical deformityLevel of Evidence: 3.
研究设计
一项回顾性队列研究。
目的
本研究旨在探讨维持水平凝视所需的颈椎排列，这取决于潜在的胸腰椎排列。
背景数据总结
颈椎矢状曲线（CC）受胸椎和整体排列的影响。最近的研究表明，正常CC的变异性很大，从脊柱前凸到脊柱后凸排列不等。以前没有研究评估过整体脊柱排列对维持水平凝视时CC的影响。
方法
纳入无脊柱手术史且在进行全身成像时能够维持水平凝视的患者。患者根据胸椎后凸（TK）分为（<30、30 - 40、40 - 50和>50），然后根据SRS - Schwab矢状垂直轴（SVA）修正值分为（后凸排列SVA <0、对齐0 - 50和错位>50mm）。在TK组的SVA分级中评估颈椎排列。对随机选择的60%的人群进行逐步线性回归分析。开发了一个简化公式，并在其余40%的人群中进行验证。
结果
在每个TK组（n = 118、137、125、197）中，随着Schwab SVA分级增加，较低的CC（C2 - C7）脊柱前凸明显增加。随着胸腰椎（C7 - S1）SVA增加，T1斜率和颈椎SVA显著增加。上颈椎（C0 - C2）以及T1斜率与CC之间的不匹配（T1 - CL）相似。回归分析显示腰椎前凸减去胸椎后凸（LL - TK）是一个独立预测因子（r = 0.640，r = 0.410），公式为：CC = 10 - （LL - TK）/2。验证表明预测的CC与实际CC之间的绝对差值为8.5°。此外，64.2%的患者预测的C2 - C7值与实际CC相差在10°以内。
结论
在相当数量的患者中，颈椎后凸可能代表正常排列。然而，在SVA >50且胸椎后凸较大的患者中，需要颈椎前凸来维持凝视。颈椎排列可根据潜在的TK和腰椎前凸进行预测，在考虑胸腰椎或颈椎畸形矫正时可能具有临床相关性。证据级别：3。
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