Ye Junhua, Roshani Ramzi, Huang Qinguo, Zheng Dongying, Zhou Qiang, Li Hong, Peng Lin, Qi Songtao, Lu Yuntao
Department of Neurosurgery, Meizhou People's Hospital (Huangtang Hospital), Meizhou, 514000, China.
Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Eur Spine J. 2025 May 30. doi: 10.1007/s00586-025-08898-7.
Posterior cervical misalignment is commonly observed in patients with degenerative cervical myelopathy (DCM), yet its clinical significance remains unclear. This study takes aim to investigate the radiological value of ligamentum flavum angle (LFA) to evaluate the implications of posterior cervical misalignment in DCM.
Baseline LFA was determined in 76 adults with normal cervical alignment. LFA was then analyzed in 155 DCM patients and categorized into enlarging (eLFA), normal (nLFA), and decreasing LFA (dLFA) groups. Cervical spine parameters and MRI findings were compared, and multiple linear regression identified factors associated with LFA changes. Static LFA on MRI and dynamic LFA (ΔLFA) on X-ray were evaluated for detecting cervical instability.
The mean LFA in normal subjects (C2/3 to C6/7) was 76.3 ± 7.2°, varying by segment and age. The LFA was significantly reduced in DCM patients (70.7 ± 11.6°). The spinal cord diameter of the adjacent vertebrae and the increased signal intensity were significant difference among eLFA, nLFA and dLFA groups. LFA correlated with vertebral body movement (β = - 3.361, P < 0.001) and cervical disc angle (β = - 0.774, P < 0.001). The static LFA cutoff for posterior slippage was 67.6°, and △LFA for instability was 12.3°.
Posterior cervical spine misalignment in DCM is closely linked to both horizontal and angular vertebral displacements, potentially exacerbating spinal cord injury. Static and dynamic LFA measurements provide valuable supplementary parameters for the accurate assessment of cervical instability.
在退行性颈椎脊髓病（DCM）患者中，颈椎后凸畸形较为常见，但其临床意义尚不清楚。本研究旨在探讨黄韧带角（LFA）在评估DCM患者颈椎后凸畸形中的影像学价值。
测定76例颈椎排列正常的成年人的基线LFA。然后对155例DCM患者的LFA进行分析，并分为增大（eLFA）、正常（nLFA）和减小LFA（dLFA）组。比较颈椎参数和MRI表现，并采用多元线性回归确定与LFA变化相关的因素。评估MRI上的静态LFA和X射线上的动态LFA（ΔLFA）以检测颈椎不稳。
正常受试者（C2/3至C6/7）的平均LFA为76.3±7.2°，因节段和年龄而异。DCM患者的LFA显著降低（70.7±11.6°）。eLFA、nLFA和dLFA组之间相邻椎体的脊髓直径和信号强度增加存在显著差异。LFA与椎体运动（β=-3.361，P<0.001）和颈椎间盘角度（β=-0.774，P<0.001）相关。后滑脱的静态LFA临界值为67.6°，不稳的ΔLFA为12.3°。
DCM患者的颈椎后凸畸形与椎体的水平和角度移位密切相关，可能会加重脊髓损伤。静态和动态LFA测量为准确评估颈椎不稳提供了有价值的补充参数。
