Ani Fares, Ayres Ethan W, Woo Diann, Vasquez-Montes Dennis, Brown Avery, Alas Haddy, Abotsi Edem J, Bortz Cole, Pierce Katherine E, Raman Tina, Smith Micheal L, Kim Yong H, Buckland Aaron J, Protopsaltis Themistocles S
Department of Orthopedic Surgery, NYU Langone Health, New York, NY.
Department of Orthopedic Surgery, Penn Medicine, Philadelphia, PA.
Clin Spine Surg. 2025 Jul 1;38(6):E306-E311. doi: 10.1097/BSD.0000000000001734. Epub 2025 Jan 6.
Retrospective cohort study.
To develop parameter thresholds obtainable from cervical radiographs that correlate with concomitant thoracolumbar malalignment.
T1 slope (T1S) is typically discussed in the context of cervical deformity and correlated with health-related quality of life outcomes. Prior research suggests that T1S is related to global alignment; however, a definition for "high" T1S has not been established. Most patients undergoing cervical surgery do not undergo full-spine imaging; therefore, obtaining a parameter associated with thoracolumbar malalignment from cervical radiographs would be beneficial.
A database of preoperative adult spinal deformity (ASD) patients was analyzed. Measures obtained from standing lateral radiographs included T1S, thoracic kyphosis (TK), sagittal vertical axis (SVA), T1-pelvic angle (TPA), pelvic tilt (PT), and pelvic incidence minus lumbar lordosis (PI-LL). Decision tree analysis was then used to determine the T1S corresponding to published thresholds for high TK (40 degrees), SVA (40 mm), TPA (25 degrees), and PT (25 degrees). Alignment between high and normal T1S patients was compared.
Two hundred twenty-six preoperative patients were included (mean: 58±16 y 62%F). Larger T1S was correlated with greater SVA ( r =0.365), TPA ( r =0.302), TK ( r =0.606), and PT ( r =0.230) (all P <0.001). Decision tree analysis yielded a threshold of 30 degrees for high T1S, which 50% of patients had. Compared with patients with T1S <30 degrees, those with T1S >30 degrees had higher TK (41.5 vs. 25.8 degrees), SVA (78.7 vs. 33.7 mm), TPA (27.6 vs. 18.3 degrees), and PT (26.3 vs. 20.8 degrees), and PI-LL (18.2 vs. 11.7 degrees) (all P <0.05). Seventy-nine percent of patients with high T1S had high TK (T1S <30=13%), 69% had high SVA (T1S <30=38%), 66% had high TPA (T1S <30=37%), 60% had PT >25 degrees (T1S <30=42%), and 47% had PI-LL >20 degrees (T1S <30=34%) (all P <0.05).
Higher T1S was associated with worse global alignment. T1S was most strongly associated with TK. A T1S=30 degrees corresponded to high TK, SVA, TPA, and PT thresholds. Therefore, surgeons should consider obtaining full-spine radiographs if a T1S >30 degrees is present on cervical imaging.
回顾性队列研究。
确定可从颈椎X线片获得的与胸腰段脊柱排列不齐相关的参数阈值。
T1斜率（T1S）通常在颈椎畸形的背景下进行讨论，并与健康相关生活质量结果相关。先前的研究表明，T1S与整体排列有关；然而，“高”T1S的定义尚未确立。大多数接受颈椎手术的患者未进行全脊柱成像；因此，从颈椎X线片获得与胸腰段脊柱排列不齐相关的参数将是有益的。
分析术前成人脊柱畸形（ASD）患者的数据库。从站立位侧位X线片获得的测量值包括T1S、胸椎后凸（TK）、矢状垂直轴（SVA）、T1-骨盆角（TPA）、骨盆倾斜（PT）以及骨盆入射角减去腰椎前凸（PI-LL）。然后使用决策树分析来确定与已公布的高TK（40度）、SVA（40毫米）、TPA（25度）和PT（25度）阈值相对应的T1S。比较高T1S患者和正常T1S患者之间的排列情况。
纳入226例术前患者（平均年龄：58±16岁；62%为女性）。较高的T1S与更大的SVA（r = 0.365）、TPA（r = 0.302）、TK（r = 0.606）和PT（r = 0.230）相关（所有P < 0.001）。决策树分析得出高T1S的阈值为30度，50%的患者达到该阈值。与T1S < 30度的患者相比，T1S > 30度的患者具有更高的TK（41.5对25.8度）、SVA（78.7对33.7毫米）、TPA（27.6对18.3度）和PT（26.3对20.8度）以及PI-LL（18.2对11.7度）（所有P < 0.05）。79%的高T1S患者存在高TK（T1S < 30度 = 13%），69%存在高SVA（T1S < 30度 = 38%），66%存在高TPA（T1S < 30度 = 37%），60%的PT > 25度（T1S < 30度 = 42%），47%的PI-LL > 20度（T1S < 30度 = 34%）（所有P < 0.05）。
较高的T1S与更差的整体排列相关。T1S与TK的相关性最强。T1S = 30度对应高TK、SVA、TPA和PT阈值。因此，如果颈椎影像学检查显示T1S > 30度，外科医生应考虑获取全脊柱X线片。
