Konishi Takamitsu, Endo Kenji, Aihara Takato, Matsuoka Yuji, Suzuki Hidekazu, Takamatsu Taichiro, Kusakabe Takuya, Sawaji Yasunobu, Nishimura Hirosuke, Murata Kazuma, Yamamoto Kengo
Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan.
J Orthop Surg (Hong Kong). 2019 Sep-Dec;27(3):2309499019876999. doi: 10.1177/2309499019876999.
The cervical spine has the largest sagittal motion in the whole spine, and cervical alignment affects the thoracic sagittal alignment. However, the effects of cervical flexion and extension on thoracic sagittal alignment have not been investigated in detail. The purpose of this study was to analyze the change of thoracic sagittal alignment following cervical flexion and extension.
A total of 55 consecutive patients (42 men and 13 women; average age 49.1 years) who presented to our department with spinal degenerative disease between January 2016 and September 2017 were enrolled in our study. Subjects with a history of trauma, infection, tumor, inflammatory disease, ossification, or cervical deformities, and those who had undergone spinal surgery were excluded. The following parameters were analyzed: occipito-axial angle (O-C2), C2 slope (C2S), C2-C7 angle, T1 slope (T1S), thoracic kyphosis, T1-T4 angle, T5-T8 angle, T9-T12 angle, lumbar lordosis, sacral slope, pelvic tilt in cervical flexion, neutral, and extension.
Cervical flexion significantly decreased O-C2, C2-C7 angles and T1S, and increased C2S. Cervical extension conversely changed these parameters. At cervical flexion, the correlation of C2-C7 angle with thoracic parameters was maintained, except for the T1-T4 angle. At cervical extension, the correlation was observed with T1S and T1-T4 angle.
Cervical flexion affects the T1S and T5-T8 angle, but there is no significant change in T1-T4 and T9 and lower spino-pelvic columns. This study suggests that T2-T4 can be considered as a stable distal end when cervical long fixation for corrective surgery is performed.
颈椎在整个脊柱中具有最大的矢状面活动度，且颈椎排列会影响胸椎矢状面排列。然而，颈椎屈伸对胸椎矢状面排列的影响尚未得到详细研究。本研究的目的是分析颈椎屈伸后胸椎矢状面排列的变化。
2016年1月至2017年9月期间，共有55例连续因脊柱退行性疾病前来我院就诊的患者（42例男性和13例女性；平均年龄49.1岁）纳入本研究。排除有创伤、感染、肿瘤、炎性疾病、骨化或颈椎畸形病史以及接受过脊柱手术的患者。分析以下参数：枕颈角（O-C2）、C2斜率（C2S）、C2-C7角、T1斜率（T1S）、胸椎后凸、T1-T4角、T5-T8角、T9-T12角、腰椎前凸、骶骨斜率、颈椎屈曲、中立位和伸展位时的骨盆倾斜度。
颈椎屈曲显著降低了O-C2、C2-C7角和T1S，并增加了C2S。颈椎伸展则相反地改变了这些参数。在颈椎屈曲时，除T1-T4角外，C2-C7角与胸椎参数的相关性得以维持。在颈椎伸展时，观察到与T1S和T1-T4角的相关性。
颈椎屈曲会影响T1S和T5-T8角，但T1-T4以及T9和更低的脊柱-骨盆柱无显著变化。本研究表明，在进行颈椎长节段固定矫正手术时，T2-T4可被视为一个稳定的远端。
