Abstract
ABSTRACT Objective: To correlate the radiographic parameters of sagittal cervical alignment with quality of life and functional capacity in patients with cervical spondylosis under conservative treatment. Methods: This is an observational and prospective study in patients with cervical spondylosis under conservative treatment and without indication for surgery. The 52 patients included were divided into three groups: axial pain, radiculopathy, and cervical myelopathy. The radiographic parameters considered were cervical lordosis (CL), cervical sagittal vertical axis (CSVA), T1 slope (TS) and the discrepancy between TS and CL (TS-CL). Quality of life and functional capacity were evaluated by the Neck Disability Index (NDI) questionnaire. Pain was assessed by the Visual Analogue Scale (VAS). The correlation between the radiographic parameters and the clinical scores was evaluated by the Pearson correlations coefficient. Results: There was no difference in cervical radiographic parameters between the three groups. In the total of the sample, the mean value of the CSVA was 17.8o (±8.3o), CL, 22.4° (± 8.8°); TS, 29.3° (±6.6°), and TS-CL, 7.0° (±7.4°). Significant inverse correlation (r= -0.3, p=0.039) was observed between NDI and CL, but there was no significant correlation between CL and VAS. CSVA (p=0.541), TS (p=0.287) and TS-CL (p=0.287) had no significantly correlated with NDI or VAS. Conclusion: Considering patients with cervical spondylosis not candidates for surgery, the only sagittal parameter that correlated with functional capacity was LC. In these patients, the correlation between cervical alignment and quality of life needs to be better characterized.
Highlights
It has been shown that in addition to the analysis of overall sagittal alignment, i.e., of the sagittal vertical axis, the pelvis plays a fundamental role in spine alignment, functioning as a tool to compensate for the loss of overall sagittal alignment and correlating with quality of life indicators.[8,12,13]
Standing out among the radiographic parameters most used to evaluate cervical alignment are cervical lordosis (CL) as defined by the Cobb method, based on lines parallel to the lower terminal plates of C2 and C7;18 the cervical sagittal vertical axis, measured by the perpendicular distance between a plumb line drawn from C2 and the posterior-superior aspect of the vertebral body of C72; and the discrepancy between the T1 slope (TS) and cervical lordosis (CL), calculated by the arithmetic expression TS–CL, which, according to some authors, acts as the cervical equivalent to the discrepancy between pelvic incidence and lumbar lordosis for the lumbar spine.[19]
There was a correlation with the cervical sagittal vertical axis (cSVA) (r = 0.3) and the TS (r = 0.3), both of them weak, but statistically significant (p = 0.04 and p = 0.03, respectively) and a moderate statistically significant correlation (r = 0.04, p < 0.001) with the CL
Summary
The cervical region is the spinal segment with the most mobility, in addition to being responsible for support of the weight of the head, and is susceptible to a series of pathologies associated with significant compromise to quality of life and functional disability.[1,2] Physiologically, the cervical segment functions in lordosis and changes to this curvature are commonly observed in patients with cervical pathologies.[2,3,4,5]Loss of the sagittal alignment of the spine is well-established as a determinant of pain and functional disability in adults.[6,7,8] The correlation between sagittal imbalance, represented by a plumb line from C7 (sagittal vertical axis), and compromised quality of life, represented by worse scores obtained from questionnaires, has been demonstrated by various studies, as well as by better postoperative clinical results obtained when alignment is restored.[9,10,11] It has been shown that in addition to the analysis of overall sagittal alignment, i.e., of the sagittal vertical axis, the pelvis plays a fundamental role in spine alignment, functioning as a tool to compensate for the loss of overall sagittal alignment and correlating with quality of life indicators.[8,12,13]Recently, the importance of the sagittal alignment of the cervical segment of the spine has been demonstrated, and that deformity of the cervical spine is associated with pain, functional disability, and even the severity of cervical myelopathy.[1,2,14,15,16,17] Standing out among the radiographic parameters most used to evaluate cervical alignment are cervical lordosis (CL) as defined by the Cobb method, based on lines parallel to the lower terminal plates of C2 and C7;18 the cervical sagittal vertical axis (cSVA), measured by the perpendicular distance between a plumb line drawn from C2 and the posterior-superior aspect of the vertebral body of C72; and the discrepancy between the T1 slope (TS) and cervical lordosis (CL), calculated by the arithmetic expression TS–CL, which, according to some authors, acts as the cervical equivalent to the discrepancy between pelvic incidence and lumbar lordosis for the lumbar spine.[19]. Loss of the sagittal alignment of the spine is well-established as a determinant of pain and functional disability in adults.[6,7,8] The correlation between sagittal imbalance, represented by a plumb line from C7 (sagittal vertical axis), and compromised quality of life, represented by worse scores obtained from questionnaires, has been demonstrated by various studies, as well as by better postoperative clinical results obtained when alignment is restored.[9,10,11] It has been shown that in addition to the analysis of overall sagittal alignment, i.e., of the sagittal vertical axis, the pelvis plays a fundamental role in spine alignment, functioning as a tool to compensate for the loss of overall sagittal alignment and correlating with quality of life indicators.[8,12,13].
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