Morimoto Yasuhiko, Shigematsu Hideki, Iwata Eiichiro, Tanaka Masato, Okuda Akinori, Masuda Keisuke, Yamamoto Yusuke, Takeshima Toshichika, Nakagawa Yoshiyuki, Tanaka Yasuhito
Nara Medical University, Kashihara City, Nara, Japan.
Uda City Hospital, Uda City, Nara, Japan.
Global Spine J. 2019 Sep;9(6):591-597. doi: 10.1177/2192568218811841. Epub 2018 Nov 15.
Retrospective review of medical charts and radiographic data.
We aimed to clarify the differences in cervical alignment findings between sitting cervical lateral radiographs and standing whole-spine lateral radiographs with clavicle positioning in cervical spondylotic myelopathy (CSM) patients.
We retrospectively evaluated the radiographs of 50 consecutive patients who underwent cervical surgery for CSM in our hospital. Cervical sagittal alignment was evaluated based on the C0-2 angles and C2-7 Gore and Cobb angles. Head position was evaluated in terms of the center of gravity of the head to C7 (CGH-C7) angle and the McGregor angle (ie, the angle between the McGregor line and a horizontal line). The T1-slope was also evaluated.
The mean values of the CGH-C7 angle and T1-slope were significantly lower, while the mean value of the McGregor angle was significantly higher on whole-spine lateral radiographs with clavicle positioning than on sitting cervical lateral radiographs. The mean values of the C0-2 and C2-7 angles did not differ significantly between the 2 radiographic positioning approaches.
Using whole-spine lateral radiographs with clavicle positioning may result in a significantly lower T1-slope and a posterior tilt of the head. In the absence of a compensatory change in cervical alignment, clavicle positioning may force patients to adopt an upward gazing position of the head. These compensatory mechanisms should be considered while evaluating cervical alignment on whole-spine lateral radiographs with clavicle positioning. Surgical planning should take into account the effect of posture on the radiographic appearance of cervical alignment.
对病历和影像学数据进行回顾性分析。
我们旨在阐明颈椎病性脊髓病（CSM）患者中，坐位颈椎侧位X线片与站立位全脊柱侧位X线片（锁骨定位）之间颈椎排列结果的差异。
我们回顾性评估了我院连续50例因CSM接受颈椎手术患者的X线片。基于C0-2角、C2-7 Gore角和Cobb角评估颈椎矢状位排列。根据头部重心至C7（CGH-C7）角和麦格雷戈角（即麦格雷戈线与水平线之间的夹角）评估头部位置。还评估了T1斜率。
锁骨定位的全脊柱侧位X线片上，CGH-C7角和T1斜率的平均值显著更低，而麦格雷戈角的平均值显著更高，相比坐位颈椎侧位X线片。两种X线片定位方法之间，C0-2角和C2-7角的平均值无显著差异。
使用锁骨定位的全脊柱侧位X线片可能导致T1斜率显著降低和头部后倾。在颈椎排列无代偿性改变的情况下，锁骨定位可能迫使患者采取抬头凝视的姿势。在评估锁骨定位的全脊柱侧位X线片上的颈椎排列时，应考虑这些代偿机制。手术规划应考虑姿势对颈椎排列影像学表现的影响。
