Abstract
ABSTRACT Objective: There are no values defined as standard in the literature for the parameters of assessment of cervical sagittal balance in patients with idiopathic scoliosis. This study describes the sagittal cervical parameters in patients with idiopathic scoliosis. Methods: Study carried out in a tertiary public hospital in patients with adolescent idiopathic scoliosis, through the evaluation of panoramic radiographs in lateral view. The Cobb method was used to evaluate cervical lordosis from C2 to C7, distance from the center of gravity (COG) of the skull to C7, measurement of T1 slope, thoracic inlet angle (TIA), neck tilt, and plumb line from C7 to S1 (SVA C7-S1). A statistical analysis was performed, to demonstrate the relationship between the alignment of the thoracic spine in the sagittal plane and the cervical sagittal balance of patients with scoliosis. Results: Thirty-four patients were female (69.4%) and 15 male (30.6%). The mean values for COG-C7 were 0.71 mm (median 0.8 mm/standard deviation [SD]= 0.51 mm). For Cobb C2-C7, the mean was -11.7° (median -10°/SD= 20.4°). The mean slope of T1 was 23.5° (median 25°/SD= 9.5°). The mean cervical version was 58.8° (median 60°/DP= 15.4°). The mean TIA was 81.8° (median 85°/SD= 16.7°). The mean plumb line C7-S1 was -0.28 (-0.3/SD= 1.0). Conclusion: The analysis of the results showed that the mean values for the cervical lordosis are lower than the values described as normal in the literature, suggesting a loss of sagittal cervical balance in these patients.
Highlights
Scoliosis is defined as a three-dimensional deformity in which the frontal plane has a lateral deviation of greater than 10 degrees
The mean plumb line C7-S1 was -0.28 (-0.3/SD= 1.0) Conclusion: The analysis of the results showed that the mean values for the cervical lordosis are lower than the values described as normal in the literature, suggesting a loss of sagittal cervical balance in these patients
That information about the relationship between thoracic kyphosis and lumbar lordosis has already been published in the literature, very little has been published about the reaction of the cervical spine to correction of deformity in idiopathic scoliosis.[2]
Summary
Scoliosis is defined as a three-dimensional deformity in which the frontal plane has a lateral deviation of greater than 10 degrees. This deformity can involve asymmetry of the shoulders and of the carriage, the presence of a prominent costal hump in the convex region of the curve, and changes in sagittal balance.[1]. Hilibrand et al.[3] were the first to confirm the radiographic relationship between cervical and thoracic alignment in the sagittal plane They noticed an inverse relationship between thoracic kyphosis and cervical lordosis in idiopathic scoliosis, in other words, the less the thoracic kyphosis the greater the loss of cervical lordosis. The inversion of the cervical lordosis can cause early degenerative changes, increasing the incidence of cervicalgia.[2,4]
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