患有垂头综合征患者的脊柱矢状面排列。
Spinal Sagittal Alignment in Patients With Dropped Head Syndrome.
机构信息
Department of Orthopedic Surgery, Tokyo, Medical University, Tokyo, Japan.
出版信息
Spine (Phila Pa 1976). 2018 Nov 1;43(21):E1267-E1273. doi: 10.1097/BRS.0000000000002685.
STUDY DESIGN
This is a retrospective radiographic study of a consecutive case series of dropped head syndrome (DHS) at a single tertiary referral center.
OBJECTIVE
The aim was to clarify the spinal sagittal alignment of DHS.
SUMMARY OF BACKGROUND DATA
DHS is characterized by chin-on-chest deformity and devastatingly impedes activities of daily living in affected individuals. Among various forms of DHS, isolated neck extensor myopathy (INEM) is considered to cause the chin-on-chest symptom in the absence of specific abnormality. There is a paucity of literature about spinal sagittal alignment, of this condition however.
METHODS
Thirty-seven patients diagnosed with INEM DHS were enrolled. Radiographic measurements were made, including the following parameters: C2 slope (C2S), C2-C7 A, C2-C7 sagittal vertical axis (SVA), T1 slope (T1S), C7-S1 SVA, T1-T4 thoracic kyphosis (TK), T4-T12 TK, lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI). Sixty-one patients with cervical spondylosis were enrolled as a control group.
RESULTS
C2-C7 SVA was greater in INEM DHS (52.0 ± 2.9 vs. 18.6 ± 1.9 mm). C2S and T1S were larger to the control (C2S: 52.6° ± 2.0° vs. 13.0° ± 1.4°, T1S: 37.3° ± 2.2° vs. 22.7° ± 1.4°). C2-C7 A was smaller in INEM DHS (-7.8° ± 2.6° vs. 15.2° ± 2.7°). Among sagittal parameters, C2S, T1S, and T1-T4 TK positively correlated with C2-C7 SVA (r = 0.63, r = 0.54, and r = 0.58). For these correlations with C2-C7 SVA, both logistic and linear regression models predicted threshold of 40° for C2S, 40° for T1S, and 15° for T1-T4 TK responsible for C2-C7 SVA > 40 mm, respectively.
CONCLUSION
Increased offset of the gravity axis of the head represented by C2-C7 SVA was observed in INEM DHS. Magnified offset of the gravity axis of the head was affected by enlarged C2S, T1S, and T1-T4 TK for the strong correlation with C2-C7 SVA, respectively. Cervical kyphosis was considered as some of the anthropometric characteristics due to regressive changes in affected individuals; a correlation between C2-C7 A and C2-C7 SVA was exhibited.
LEVEL OF EVIDENCE
研究设计
这是一项在单一三级转诊中心进行的连续病例系列的落头综合征（DHS）回顾性影像学研究。
目的
旨在阐明 DHS 的脊柱矢状位排列。
背景资料概要
DHS 的特征是下巴碰到胸部的畸形，严重影响受影响个体的日常生活活动。在各种形式的 DHS 中，孤立性颈伸肌肌病（INEM）被认为在没有特定异常的情况下导致下巴碰到胸部的症状。然而，关于这种情况的脊柱矢状位排列的文献很少。
方法
纳入了 37 名被诊断为 INEM DHS 的患者。进行了影像学测量，包括以下参数：C2 斜率（C2S）、C2-C7 A、C2-C7 矢状垂直轴（C2-C7 SVA）、T1 斜率（T1S）、C7-S1 SVA、T1-T4 胸椎后凸（TK）、T4-T12 TK、腰椎前凸（LL）、骶骨倾斜（SS）、骨盆倾斜（PT）和骨盆入射角（PI）。纳入了 61 名患有颈椎病的患者作为对照组。
结果
INEM DHS 的 C2-C7 SVA 更大（52.0±2.9 与 18.6±1.9 mm）。C2S 和 T1S 均大于对照组（C2S：52.6°±2.0°与 13.0°±1.4°，T1S：37.3°±2.2°与 22.7°±1.4°）。INEM DHS 的 C2-C7 A 较小（-7.8°±2.6°与 15.2°±2.7°）。在矢状位参数中，C2S、T1S 和 T1-T4 TK 与 C2-C7 SVA 呈正相关（r=0.63、r=0.54 和 r=0.58）。对于与 C2-C7 SVA 的这些相关性，逻辑和线性回归模型均预测 C2S 的阈值为 40°、T1S 的阈值为 40°和 T1-T4 TK 的阈值为 15°，这三个阈值均会导致 C2-C7 SVA > 40mm。
结论
在 INEM DHS 中观察到代表头部重力轴偏移的 C2-C7 SVA 增加。头部重力轴的放大偏移受到 C2S、T1S 和 T1-T4 TK 的影响，这三个因素与 C2-C7 SVA 有很强的相关性。颈椎后凸被认为是受影响个体退行性变化的一些人体测量特征之一；C2-C7 A 与 C2-C7 SVA 之间存在相关性。
证据水平
4。
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