University Orthopaedics, Hand and Reconstructive Microsurgery Cluster (UOHC), National University Health System, Singapore.
Spine (Phila Pa 1976). 2017 Nov 1;42(21):1614-1621. doi: 10.1097/BRS.0000000000002160.
Comparative study of prospectively collected radiographic data.
To predict physiological alignment of the cervical spine and study its morphology in different postures.
There is increasing evidence that normal cervical spinal alignment may vary from lordosis to neutral to kyphosis, or form S-shaped or reverse S-shaped curves.
Standing, erect sitting, and natural sitting whole-spine radiographs were obtained from 26 consecutive patients without cervical spine pathology. Sagittal vertical axis (SVA), global cervical lordosis, lower cervical alignment C4-T1, C0-C2 angle, T1 slope, C0-C7 SVA and C2-7SVA, SVA, thoracic kyphosis, thoracolumbar junctional angle, lumbar lordosis, sacral slope, pelvic tilt, and pelvic incidence were measured. Statistical analysis was performed to elucidate differences in cervical alignment for all postures. Predictive values of T1 slope and SVA for cervical kyphosis were evaluated.
Most patients (73.0%) do not have lordotic cervical alignment (C2-C7) upon standing (mean -0.6, standard deviation 11.1°). Lordosis increases significantly when transitioning from standing to erect sitting, as well as from erect to natural sitting (mean -17.2, standard deviation 12.1°). Transition from standing to natural sitting also produces concomitant increases in SVA (-8.8-65.2 mm) and T1-slope (17.4°-30.2°). T1 slope and SVA measured during standing significantly predicts angular cervical spine alignment in the same position. SVA < 10 mm significantly predicts C4-C7 kyphosis (P < 0.001), and to a lesser extent, C2-C7 kyphosis (P = 0.02). T1 slope <20° is both predictive of C2-C7 and C4-7 kyphosis (P = 0.001 and P = 0.023, respectively). For global cervical Cobb angle, T1 slope seems to be a more significant predictor of kyphosis than SVA (odds ratio 17.33, P = 0.001 vs odds ratio 11.67, P = 0.02, respectively).
The cervical spine has variable normal morphology. Key determinants of its alignment include SVA and T1 slope. Lordotic correction of the cervical spine is not always physiological and thus correction targets should be individualized.
前瞻性收集的影像学资料的对比研究。
预测颈椎的生理排列，并研究其在不同姿势下的形态。
越来越多的证据表明，正常的颈椎排列可能从前凸变为中立位到后凸，或者形成 S 形或反 S 形曲线。
对 26 例无颈椎疾病的连续患者进行站立位、直立坐位和自然坐位全脊柱 X 线片检查。测量矢状垂直轴（SVA）、颈椎总前凸角、下颈椎 C4-T1 排列、C0-C2 角、T1 斜率、C0-C7SVA 和 C2-7SVA、SVA、胸椎后凸角、胸腰椎交界角、腰椎前凸角、骶骨倾斜角、骨盆倾斜角和骨盆入射角。对所有体位的颈椎排列差异进行统计学分析。评估 T1 斜率和 SVA 对颈椎后凸的预测价值。
大多数患者（73.0%）站立时颈椎排列无前凸（C2-C7）（平均-0.6°，标准差 11.1°）。从站立位到直立坐位以及从直立位到自然坐位时，前凸明显增加（平均-17.2°，标准差 12.1°）。从站立位到自然坐位还会同时导致 SVA（-8.8-65.2mm）和 T1 斜率（17.4°-30.2°）增加。站立位测量的 T1 斜率和 SVA 显著预测同一位置的颈椎角度排列。SVA＜10mm 可显著预测 C4-C7 后凸（P＜0.001），较小程度上也可预测 C2-C7 后凸（P=0.02）。T1 斜率＜20°既能预测 C2-C7 后凸，也能预测 C4-7 后凸（P=0.001 和 P=0.023）。对于颈椎总 Cobb 角，T1 斜率似乎比 SVA 更能预测后凸（比值比 17.33，P=0.001 与比值比 11.67，P=0.02）。
颈椎具有不同的正常形态。其排列的关键决定因素包括 SVA 和 T1 斜率。颈椎的前凸矫正并不总是生理性的，因此矫正目标应个体化。
3 级。
