Nukii Wataru, Fukazawa Takahiro, Higo Yukihiro, Yamanaka Rio, Uchino Ami, Kato Naoto, Tsubaki Natsume, Nakanishi Kazuyoshi, Sawada Hirokatsu, Niimi Masachika
Rehabilitation Medicine, Nihon University Graduate School of Medicine, Tokyo, JPN.
Rehabilitation Medicine, Nihon University School of Medicine, Tokyo, JPN.
Cureus. 2025 Apr 10;17(4):e82044. doi: 10.7759/cureus.82044. eCollection 2025 Apr.
Introduction Hyperkyphosis is a deformity of the spine's forward curvature in the sagittal alignment, and its indices include the sagittal vertical axis (SVA), thoracic kyphosis (TK), and lumbar lordosis angle (LLA). These indices are difficult to evaluate in patients who cannot maintain a standing position. Therefore, we sought to determine whether the mean clavicular tilt angle, which can be evaluated regardless of the patient's posture, can be used as an indicator of hyperkyphosis. We hypothesized that the mean clavicular tilt angle would correlate with established sagittal spinal alignment parameters and could serve as a reliable surrogate indicator of hyperkyphosis in patients unable to stand. Hyperkyphosis can be evaluated using the indices that require standing or sitting. However, no studies have attempted to evaluate hyperkyphosis regardless of the patient's posture. Methods This retrospective study analyzed 106 patients (aged ≥65 years) who underwent surgery for lumbar spinal canal stenosis at our hospital between March 2023 and July 2024. All patients had both a plane radiography of the frontal plane including the clavicle and a plane radiography of the entire spine in the sagittal plane from the cervical spine to the pelvis taken before surgery. The mean clavicular tilt angle was measured using two methods: the conventional method and a newly devised method. The new method modifies the angle reference point to enhance applicability in cases with extreme postural deformities. The correlation between the clavicular tilt angle and SVA, TK, and LLA was examined for each method. Results A positive correlation (r = 0.343, p < 0.05) was found between the mean clavicular tilt angle and TK using the conventional method. A positive correlation (r = 0.562, p < 0.05) was found between the mean clavicular tilt angle and SVA using the new method, and a negative correlation (r = -0.437, p < 0.05) was found between the mean clavicular tilt angle and LLA using the new method, indicating moderate to strong correlations with spinal alignment parameters. Conclusions This study suggests that the mean clavicular tilt angle may be a useful indicator of hyperkyphosis. In particular, the new measurement method may serve as a practical tool for evaluating hyperkyphosis in frail or immobile populations. However, being a single-center retrospective study, these findings require validation through larger prospective studies.
引言
脊柱后凸是脊柱矢状位排列中向前弯曲的一种畸形，其指标包括矢状垂直轴（SVA）、胸椎后凸（TK）和腰椎前凸角（LLA）。对于无法保持站立姿势的患者，这些指标难以评估。因此，我们试图确定无论患者姿势如何均可评估的平均锁骨倾斜角是否可作为脊柱后凸的一个指标。我们假设平均锁骨倾斜角将与既定的脊柱矢状位排列参数相关，并可作为无法站立患者脊柱后凸的可靠替代指标。脊柱后凸可使用需要站立或坐立的指标进行评估。然而，尚无研究尝试在不考虑患者姿势的情况下评估脊柱后凸。
方法
这项回顾性研究分析了2023年3月至2024年7月在我院接受腰椎管狭窄手术的106例患者（年龄≥65岁）。所有患者在手术前均进行了包括锁骨的正位平面X线摄影以及从颈椎到骨盆的全脊柱矢状位平面X线摄影。平均锁骨倾斜角采用两种方法测量：传统方法和新设计的方法。新方法修改了角度参考点，以增强在极端姿势畸形情况下的适用性。对每种方法检查锁骨倾斜角与SVA、TK和LLA之间的相关性。
结果
使用传统方法时，平均锁骨倾斜角与TK之间存在正相关（r = 0.343，p < 0.05）。使用新方法时，平均锁骨倾斜角与SVA之间存在正相关（r = 0.562，p < 0.05），且使用新方法时平均锁骨倾斜角与LLA之间存在负相关（r = -0.437，p < 0.05），表明与脊柱排列参数存在中度至强相关性。
结论
本研究表明平均锁骨倾斜角可能是脊柱后凸的一个有用指标。特别是，新的测量方法可能成为评估体弱或行动不便人群脊柱后凸的实用工具。然而，作为一项单中心回顾性研究，这些发现需要通过更大规模的前瞻性研究进行验证。
