Cervical Lordosis Angle Research Articles

Cervical kyphosis in asymptomatic populations: incidence, risk factors, and its relationship with health-related quality of life

BackgroundCervical kyphosis has been pointed out in asymptomatic populations. The purposes of this study were (1) to investigate the incidence of cervical kyphosis in asymptomatic populations, (2) to identify risk factors related to cervical kyphosis, and (3) to assess the relationship between cervical kyphosis and health-related quality of life (HRQOL).MethodsA cohort of 235 asymptomatic volunteers’ records was retrospectively analyzed. Radiographic parameters of the coronal and sagittal planes were measured in the full-length spine x-ray. All patients were classified into two groups based on the cervical lordosis angle: cervical lordosis (CL) and cervical kyphosis (CK). HRQOL was evaluated by EQ-5D and SF-36 (PCS and MCS) questionnaires.ResultsCK was observed in 90 of 235 (38.3%) participants. There was a significant difference with regard to age between volunteers with CK and CL (32.23 ± 8.12 vs. 42.12 ± 6.14, p < 0.05). Several parameters had a significant relationship with CK, including TK, T1 slope, TIA, SVA, and CT. Logistic regression analysis identified age, TK, T1 slope, and SVA as independent risk factors of CK. In addition, there was a negative correlation between CK and the parameters of HRQOL (EQ-5D, − 0.63; PCS, − 0.68; MCS, − 0.59).ConclusionsThe incidence of CK in normal populations is 38.3%. Some spinal parameters are related to CK. CK is associated with the HRQOL.

Analysis of the Effect of Surgical Treatment for the Patients with Hirayama Disease from the Perspective of Cervical Spine Sagittal Alignment

This study was carried out to analyze the surgical effect of cervical spine sagittal alignment for patients with Hirayama disease (HD). Forty-four subjects were retrospectively analyzed for the parameters of cervical spine sagittal alignment. The case group consisted of 23 patients with HD, whereas the control group consisted of 21 healthy adolescent subjects. Pre- and postoperative cervical spine sagittal parameters of the patients with HD were collected; the cervical sagittal parameters of the healthy adolescent subjects were also collected. Sagittal alignment parameters were compared between the patients with HD and the healthy adolescent subjects, and between the pre- and postoperative parameters for the patients with HD. Forty-four subjects completed the follow-up, with the average follow-up period being 18.0 months. No significant differences were detected between the HD and control groups for clinical parameters (P > 0.05). The preoperative HD group had smaller values compared with the control group in the sagittal parameters of C2-7 cervical lordosis (CL) angle, T1 slope, thoracic inlet angle (TIA), and cervical tilt angle (P < 0.05). For the patients with HD, the preoperative values were smaller compared with the postoperative HD values for the parameters of C2-7 CL angle, T1 slope, and cervical tilt angle (P < 0.05). We found no significant differences between the postoperative patients with HD and the healthy subjects, including C2-7 CL angle, C2-7 sagittal vertical axis, T1 slope, TIA, neck tilt angle, cervical tilt angle, and cranial tilt angle (P > 0.05). Patients with HD have sagittal imbalance of the cervical spine compared with age-matched healthy adolescent subjects, and surgical treatment could correct the sagittal imbalance.

Compensatory Mechanisms for Kyphotic Change in the Cervical Spine According to Alignment Analysis of the Cases after Anterior Cervical Corpectomy and Fusion

Compensatory mechanisms for cervical kyphosis are unclear. Few alignment analyses have targeted ongoing cervical kyphosis and detailed the effects of compensatory alignment changes. We analyzed the radiographic alignment parameters of 31 patients (21 men and 10 women) with postoperative kyphotic changes after anterior cervical corpectomy and fusion (ACCF) between 2006 and 2015. This analysis included lordotic angle of the fusion area, fusion area length, cervical lordosis angle (CL), O-C7 angle (O-C7a), and cervical sagittal vertical axis (cSVA) as basic parameters and occipito-C2 angle (O-C2a), adjacent cranial angle, adjacent caudal angle, and T1 slope as compensatory parameters at 2 time points after surgery. Alignment analysis revealed that CL was significantly decreased by 5.0 ± 7.7° (P < 0.01) and O-C7a was changed by only-0.2 ± 6.8° (P= 0.75). An inverse correlation was found between ΔCL and ΔO-C2a (ρ=-0.40), with a nearly 1:1 relationship in the scatter diagram. ΔT1 slope had no direct compensatory correlation with ΔCL (P= 0.28) but was strongly correlated with ΔcSVA (ρ= 0.78). The scatter diagram of ΔcSVA and ΔT1 slope showed compensatory relevance and a shifted point to its collapse as the T1 slope lost control of cSVA; thereafter, both parameters incessantly increased, and ΔT1 and ΔcSVA became positive. When CL decreased after ACCF, ΔO-C2 immediately compensated for the CL loss that could lead to failure to obtain horizontal gaze. If cSVA increased, Δcaudal adjacent angle and ΔT1 slope (extension below the kyphosis) compensated for the horizontal offset translation. The noncompensatory status (ΔcSVA and ΔT1 positive) may necessitate further correction surgery in which the caudal fused level is beyond T1.

Incidence and Risk Factors of Cervical Kyphosis in Patients with Adolescent Idiopathic Scoliosis

Cervical kyphosis (CK) has been reported in patients with adolescent idiopathic scoliosis (AIS). The report about the incidence of CK between patients with AIS and normal populations was little. Patients included in previous studies often required scoliosis surgery (Cobb angle ≥40°), which does not represent all patients with AIS. The aims of this study were to compare incidence of CK between patients with AIS (Cobb angle >10°) and an age-matched normal population and to identify risk factors related to CK, especially coronal parameters that have rarely been studied in current literature. Patients with AIS (n= 112) and asymptomatic subjects from the general population (control group; n= 40) were retrospectively analyzed. Radiographic parameters of coronal and sagittal plane were measured on full-length spine x-rays. Patients with AIS were divided into 2 groups based on cervical lordosis angle: cervical lordosis and CK. CK was observed in 14 of 40 (35%) subjects in the control group and 68 of 112 (60.7%) patients with AIS. Several parameters were related to CK, including major curve, proximal thoracic, and main thoracic Cobb angle; proximal thoracic kyphosis angle; main thoracic kyphosis angle; T1 slope; sagittal vertical axis; vertical distance between C7 plumb line and center sacral vertical line; apical vertebral translation; T1 coronal tilt; and lumbar pelvic relationship. Logistic regression identified main thoracic Cobb angle, main thoracic kyphosis angle, sagittal vertical axis, lumbar pelvic relationship, and apical vertebral translation as independent risk factors of CK. Incidence of CK increases in patients with AIS relative to normal subjects. Coronal parameters of the spine could influence cervical sagittal alignment.

A Computed Tomographic Assessment of Tracheostomy Tube Placement in Patients with Chronic Neurological Disorders: The Prevention of Tracheoarterial Fistula.

Objective Tracheoarterial fistula (TAF) is a rare but devastating complication of tracheostomy caused by pressure necrosis from the elbow, tip, or over-inflated cuff of the tracheostomy tube. The incidence of TAF is reportedly higher in patients with neurological disorders than in those without such disorders. To evaluate the incidence of and factors contributing to the misalignment of tracheostomy tubes in bedridden patients with chronic neurological disorders. Methods We retrospectively assessed three-dimensionally reconstructed serial computed tomography (CT) images to see if the tip of the tube made contact with the tracheal wall and if the main arteries were running adjacent to the tube's elbow, tip or cuff. Results The tip of the tube was in contact with the tracheal wall in 14 of the 30 patients assessed. Among them, the tip was adjacent to the innominate artery in eight, the aortic arch in three and an aberrant right subclavian artery in one. In one patient with the tube tip adjacent to the aortic arch and the other four patients, the cuff of the tube was adjacent to the innominate artery across the tracheal wall. Patients with the tube tip in contact with the anterior tracheal wall had a significantly greater cervical lordosis angle than those without contact (p<0.05). Conclusion More than half of tracheostomized patients with chronic neurological disorders had a latent risk of TAF. The variability in the location of the innominate artery, anomalies of the aortic arch, and skeletal deformities may therefore be contributing factors.

The time course of cervical alignment after cervical expansive laminoplasty: Determining optimal cut-off preoperative angle for predicting postoperative kyphosis.

Retrospective Cohort studyTo analyze cervical lordosis angle (CLA) change after cervical expansive laminoplasty (CEL) over time, and to determine optimal cut-off angle for predicting postoperative kyphosisPostoperative development of sagittal malalignment after laminoplasty is associated with neurological dysfunction and neck pain. However, there is no information on the serial CLA change over time and cut-off angle for predicting postoperative kyphosisThe Cobb angle between C2 and C7 in a series of lateral cervical X-rays in the neutral position was retrospectively reviewed for 36 months. And, the effect of time on CLA after CEL and the risk factors associated with postoperative cervical kyphosis (Cobb's angle ≤0°) were analyzed. Also, the optimal cut-off angle for predicting postoperative kyphosis was determined.A total of 110 cases of CEL for cervical myelopathy were enrolled from February 2005 to May 2010. The mean cervical alignment changed from 12.3 ± 10.4° (mean ± standard deviation [SD]) at the preoperative evaluation to 8.2 ± 11.6°, 10.6 ± 10.1°, 9.1 ± 10.0°, 8.4 ± 11.2°, 8.5 ± 10.5°, 8.1 ± 9.9°, and 8.7 ± 10.1° at 1, 3, 6, 12, 18, 24, and 36 postoperative months, respectively. The cervical lordosis showed statistically significant decreased at the 1st month, then the lordotic angle was partially restored at the 3rd, and 6th, and then no significant changes after the 6th. The only risk factor for kyphosis development was the preoperative CLA. The optimal cut-off preoperative angle for predicting postoperative kyphosis was 8.5°.The decrease of CLA after expansive laminoplasty peaked in the 1st month. Some of the lordotic angles were restored in the 3rd and 6th months, before reaching a plateau after the 6th month. The optimal cut-off preoperative angle for predicting postoperative kyphosis was 8.5°.Level of Evidence of their study: Level 4.

Analysis of Head Posture and Activation of the Cervical Neck Extensors During a Low-Load Task in Women With Chronic Migraine and Healthy Participants

ObjectiveThe purpose of this study was to investigate the correlation between head and neck posture and superficial neck flexor and extensor activity during performance of the craniocervical flexion test (CCFT) in women with migraine and healthy controls. MethodsFifty-two women with episodic migraine, 16 with chronic migraine, and 23 healthy controls participated. Head and neck posture were determined by assessing the craniovertebral (CV) angle and cervical lordosis angle. Surface electromyography signals were recorded bilaterally from sternocleidomastoid, anterior scalene, splenius capitis, and upper trapezius muscles as participants performed the CCFT. Differences in electromyogram activity and posture among groups were compared with analyses of variance. Correlations between posture and electromyogram activity were analyzed with the Pearson correlation coefficient. ResultsBoth migraine groups had a significant increase in splenius capitis muscle activity, when acting as an antagonist, at the last stage of CCFT (F = 4.687; P = .012) compared with controls. No differences among groups were observed for head and neck posture. No significant correlation was found in the episodic migraine group. Moderate correlations between the CV angle and upper trapezius activity at the majority stages of the CCFT (-0.61 < r < -0.65, all P < .05) were observed within the chronic migraine group: the more extended the head posture, the higher the activity of the upper trapezius muscle. The CV angle also was correlated with upper trapezius muscle activity at the first stage of the CCFT and with splenius capitis muscle activity at the last stages (-0.42 < r < -0.52; P < .05). ConclusionAn extended (forward) head posture was moderately correlated with an increased in electrical activity of superficial neck extensor muscles, particularly the upper trapezius, when acting as an antagonist, during the performance of the CCFT in women with chronic but not episodic migraine.

Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters: P127. Redefining the cervical disability threshold of T1 slope minus cervical lordosis

BACKGROUND CONTEXT A T1 Slope minus cervical lordosis (TS-CL) angle of 20° has been described in the literature as a significant cutoff to define cervical deformity, however recent studies suggest that this cutoff needs to be redefined. PURPOSE The aim of this study was to develop a novel TS-CL threshold indicative of moderate to severe cervical disability. STUDY DESIGN/SETTING Single-center retrospective review. PATIENT SAMPLE A total of 69 cervical patients indicated for surgical treatment were included. OUTCOME MEASURES T1 slope minus cervical lordosis, neck disability index (NDI). METHODS Patients age 18years old with a primary cervical diagnosis indicated for surgical treatment were included. Patients with active infection, tumors or trauma were excluded. We tested possible cutoffs for TS-CL against the percentage of individuals meeting normative, mild, moderate (>25) and severe (>35) NDI scores at baseline. The TS-CL cutoff with the highest sensitivity to predict a normative, mild, moderate (>25) and severe (>35) NDI score was selected. RESULTS A total of 69 cervical patients indicated for surgical treatment were included (mean age 55.4±9.9years, 45% female, mean BMI 29.1±6.6 kg/m2). The average baseline NDI score was 39.9±20.9 for this cohort. At baseline, average TS-CL was 27.3°±18.8°, CL was 1.7°±17.6°, cSVA was 28.3 mm±17.3 mm. Spino-pelvic alignment parameters at baseline were as follows: PT 16.1°±8.3°, PI-LL −2.8°±11.9°, TK 38.8°±12.7° and SVA −6.3 mm±51.8 mm. Using previously established TS-CL severity breakdowns, 13 (18.8%) patients had mild TS-CL ( 20°). Using this cutoff of 20° as severe TS-CL, it did not correlate with NDI score (P=.390). After testing possible cutoffs of TS-CL that relate to moderate to severe NDI scores, a novel cutoff of 30.65° for TS-CL was related to an NDI score of ³25 points. CONCLUSIONS In a cohort of cervical surgery patients, a novel cutoff of 30.65°for TS-CL was predictive of moderate to severe neck disability, as described as an NDI score greater than or equal to 25 points. This criterion can be applied to cervical spine patients to better assess cervical disability.

The relationship between neck pain and cervical alignment in patients with temporomandibular disorders

ABSTRACTObjective: To elucidate the impact of neck pain on cervical alignment in patients with TMDs.Method: Patients diagnosed with TMDs between November 2013 and November 2015 were included. All subjects underwent lateral cervical X-ray evaluation and completed the RDC/TMD Axis II Biobehavioral Questionnaire for TMDs. Patients with neck pain also completed the Neck Pain & Disability Scale (NPDS). Cervical lordosis angle was measured according to C2-C7 Cobb’s method.Results: The mean cervical lordosis angle of the whole group (n = 60) revealed hypolordosis (10.9 ± 12.7°). Cervical lordosis angle did not differ between patients with (n = 28) and without (n = 32) neck pain (12.2 ± 12.8° versus 9.8 ± 12.7°, respectively; p = 0.46). TMD-related variables were not correlated with cervical alignment but were moderately correlated with NPDS score, with the exception of TMD-associated disability.Conclusion: Patients with TMDs have hypolordotic cervical malalignment (tendency toward kyphosis) regardless of neck pain.

Basilar Invagination: A Craniocervical Kyphosis

For more than a century, odontoid process prolapse, which compresses cranial base structures, has been the hallmark of basilar invagination (BI). The angulation of the whole skull toward the cervical spine may be considered to contribute to BI and odontoid prolapse. The objective of this study was to evaluate the craniocervical angular craniometry of patients with BI compared with patients with Chiari malformation (CM) and normal subjects. Angular craniocervical relationships among midline magnetic resonance imaging scans from patients with BI, patients with CM, and normal subjects were evaluated and compared. Angles were measured by Meazure 2.0 software from digitalized images. Using data from 121 images, 42 patients with BI (14 type I BI, 28 type II BI), 47 patients with CM, and 32 control subjects were evaluated. The BI group had a more acute kyphotic angle than the CM group (P < 0.01) and control group. The kyphosis difference was 17.57 ± 2.3° (P < 0.01) between the BI and CM groups and 21.19 ± 2.3° (P < 0.01) between the BI and control groups. Basal angles were significantly larger in the BI group compared with the other 2 groups. A strong correlation was found with kyphosis and CLV and the clivus-canal angle and cervical lordosis angle (P < 0.01). Craniocervical kyphosis in patients with BI was approximately 20° greater than in normal subjects and patients with CM. Craniocervical kyphosis should be considered a pathophysiologic condition in BI.

Association between cervical lordotic curvature and cervical muscle cross‐sectional area in patients with loss of cervical lordosis

Disruption of the cervical lordotic curve can cause undesirable symptoms such as neck pain, and cord compression. The purpose of this study was to investigate the biomechanics of loss of cervical lordosis by measuring the cross-sectional area (CSA) of the cervical muscles using magnetic resonance imaging (MRI), and to determine the relationship between cervical lordosis angle and cervical muscle status. The cervical lordosis angle was measured on standing lateral plain radiography using the posterior tangent technique in patients who complained of neck pain. The CSAs of the cervical flexor muscles including the longus cervicis and longus capitis, the cervical extensor muscles including the splenius capitis and semispinalis capitis, and the sternocleidomastoid muscle, were measured at the maximum levels by axial T1-weighted MRI. We compared neck muscle CSAs between the two groups, the correlation with cervical lordosis angle, and muscle status including CSA and imbalance. The CSA of the semispinalis capitis was significantly lower in the loss of cervical lordosis group, and the ratio of cervical flexor to extensor was significantly different between the two groups (P < 0.05). Partial correlation analysis revealed that the cervical lordotic angle was significantly positively correlated with the ratio of flexor to extensor muscle CSAs (P < 0.05). There is a significant relationship between cervical muscle imbalance, including extensor muscle weakness, and loss of cervical lordosis. An exercise program focusing on cervical extensor muscle strengthening and restoring the balance of flexor and extensor muscles is recommended for patients with loss of cervical lordosis. Clin. Anat. 31:710-715, 2018. © 2018 Wiley Periodicals, Inc.

Cervical Spine and Cord Angle Mismatch in the Pathogenesis of Myelopathy

Cervical myelopathy is a complex pathology and dynamic compression of the tethered cervical cord, which may be responsible for clinical symptoms. Patients with cervical canal stenosis who had magnetic resonance imaging in flexion and extension positions were retrospectively reviewed. All cases were evaluated in Nurick grade. The cervical parameters-cervical cord (CC) angle, cervical lordosis, and spine/cord (S/C) angle ratio-were measured on the magnetic resonance imaging. Mean values of these parameters were compared between nonmyelopathic (Nurick grade 0) and myelopathic groups (Nurick grades 1-5). A multinomial ordinal logistic regression was used to predict outcome for Nurick grade using the CC angle, the cervical lordosis angle, and the S/C angle ratio as independent variables. A total of 65 patients (35 men) with the mean age of 58.6 ± 11.4 years were analyzed. A comparison of means between Nurick grade 0 against each of myelopathic grades 1-5 revealed significant differences only for the S/C angle ratio. A cumulative comparison between nonmyelopathic and myelopathic grades for the S/C angle ratio showed significant difference of 0.29 (1.16 ± 0.5 vs. 1.45 ± 0.6, respectively; P < 0.05). Cumulative comparison for the CC angle difference in flexion and extension lordosis did not show substantial differences. The S/C angle ratio was the only significant parameter in the prediction of the Nurick grade with an odds ratio of 2.63 (95% confidence interval 2.11-2.79). A positive correlation between Nurick grade and cervical spine and cord angle mismatch was found.

The Effect of Technological Devices on Cervical Lordosis.

PURPOSE:There is a need for cervical flexion and even cervical hyperflexion for the use of technological devices, especially mobile phones. We investigated the effect of this use on the cervical lordosis angle.MATERIAL AND METHODS:A group of 156 patients who applied with only neck pain between 2013–2016 and had no additional problems were included. Patients are specifically questioned about mobile phone, tablet, and other devices usage. The value obtained by multiplying the year of usage and the average usage (hour) in daily life was determined as the total usage value (an average hour per day x year: hy). Cervical lordosis angles were statistically compared with the total time of use.RESULTS:In the general ROC analysis, the cut-off value was found to be 20.5 hy. When the cut-off value is tested, the overall accuracy is very good with 72.4%. The true estimate of true risk and non-risk is quite high. The ROC analysis is statistically significant.CONCLUSION:The use of computing devices, especially mobile telephones, and the increase in the flexion of the cervical spine indicate that cervical vertebral problems will increase even in younger people in future. Also, to using with attention at this point, ergonomic devices must also be developed.

Anterior corpectomy and reconstruction using dynamic cervical plate and titanium mesh cage for cervical spondylotic myelopathy: A minimum 5-year follow-up study.

Anterior cervical corpectomy and fusion (ACCF) is an effective surgical technique for cervical spondylotic myelopathy (CSM). However, no data exist regarding long-term outcomes after ACCF with the dynamic cervical plate for CSM. This study aimed to provide minimum 5-year clinical and radiographic outcomes of anterior corpectomy and reconstruction using dynamic cervical plate and titanium mesh cage (TMC) for CSM.Thirty-five patients who underwent single- or 2-level ACCF with dynamic cervical plate and TMC for the treatment of CSM were retrospectively investigated. The Japanese Orthopedic Association (JOA) score was used to assess the clinical outcome. Radiographic evaluations included TMC subsidence, fusion status, cervical lordosis, segmental angle, and segmental height.Twenty-eight patients underwent single-level and 7 patients underwent 2-level corpectomy with a mean follow-up period of 69.5 months. The average preoperative JOA score was 11.3 ± 3.0 and improved significantly to 14.2 ± 2.0 at the last follow-up (P < .001). Both cervical lordosis (P = .013) and segmental angle (P = .001) were significantly increased toward lordosis at the last follow-up. The TMC subsidence rate was 31.4% (n = 11) at the last follow-up. There was no significant difference in JOA recovery rate between subsidence and no subsidence group (P = .43). All patients obtained solid fusion at 1-year follow-up.Anterior corpectomy and reconstruction with dynamic cervical plate and TMC might be an effective method for the treatment of CSM at a minimum 5-year follow-up. It can maintain or restore cervical sagittal alignment. Subsidence of the TMC did not influence the clinical outcome.

Analysis of reason for postoperative axial pain caused by unilaterally open-door cervical laminoplasty

To explore the reason of postoperative axial pain (PAP) complication caused by unilaterally open-door cervical laminoplasty with Centerpiece mini-plate fixations for the treatment of multilevel cervical spondylotic myelopathy(CSM). The clinical data of 79 patients with CSM who underwent unilaterally open-door cervical laminoplasty from January 2010 to December 2013 were retrospectively analyzed. There were 45 males and 34 females, aged from 48 to 75 years old with an average of (58.7±4.4) years, complicated with ossified posterior longitudinal ligament(OPLL) of 42 cases. Courses of disease were from 2.1 to 3.9 years with an average of (3.0±0.4) years. Decompression segment occurred in C₃-C₆ of 31 cases, C₃-C₇ of 9 cases, C₄-C₇ of 39 cases. The condition of PAP was record. Cervical curvature index, cervical lordosis angle, the rate of cervical instability, the motion of flexion and extension between PAP group and non-PAP group were compared preoperatively. Multivariate non-linear regression analysis was used to verify relationship between aforementioned parameters and incidence of PAP. JOA score of preoperative, postoperative 6 months and initial onset of PAP, the improvement rate of JOA score and Odom criteria at final follow-up were used to evaluate curative efficacy. All the patients were followed up from 26 to 44 months with an average of (36±9) months. Among them, 12 patients occurred PAP who receive the conservative treatment. The rate of preoperative cervical instablility of PAP group were higher than that of non-PAP group(P<0.05). Preoperative cervical instability was the only independent risk factor in predicting occurrence of PAP. There were no significant differences in cervical curvature, cervical lordosis index, the motion of flexion and extension between PAP and non-PAP group before operation. There were no significant differences in the improvement of nerve function and clinical effect between PAP and non-PAP group after operation(P>0.05). Preoperative cervical instability is prone to inducing the respectively intervertebral motion disorder and imbalance of stress redistribution, which results in PAP after cervical unilateral laminoplasty. Correct treatment of preoperative cervical instability is a key factor to prevent the occurrence of PAP after cervical laminoplasty, which would not affect long-term nerve functional recovery pronouncedly.

Posterior enlargement of spinal canal for the treatment of multi-segmental cervical diseases without cervical lordosis

Objective To evaluate the feasibility and efficacy of posterior enlargement of spinal canal for the treatment of multi-segmental cervical diseases without cervical lordosis. Methods From January 2013 to June 2017, a retrospective study was conducted with 21 patients of multi-segmental cervical diseases accompanied cervical lordosis loss, and the complete follow-up data was obtained. There were 14 males and 7 females, with an average age of 53.9±7.3 years (range, 42-65 years). There were 14 multi-segmental cervical spondylotic myelopathy, 5 ossification of posterior longitudinal ligament, and 2 congenital cervical stenosis included in this study. The cervical lordotic angle and cervical curvature index were measured preoperatively and 1 year postoperatively. To access the enlargement of spinal canal and spinal cord, the anteroposterior diameter and cross section area of spinal canal or spinal cord were measured on MRI preoperatively and 1 year postoperatively. The Japanese Orthopaedic Association Scores (JOA) was applied to evaluate the neurological function at preoperation and postoperation. Visual Analogue Scales (VAS) was applied to evaluate the pain degree at preoperation and postoperation. Frankel classification was used to assess the severity of spinal cord injury at preoperation and postoperation. Results The follow-up time was 12-26 months, with an average of 16.4 months. The cervical lordosis angle was 3.1°±2.3° preoperatively, and 4.2°±1.6° 1 year postoperatively with a significant difference. The cervical curvature index was 4.4%±1.7% preoperatively and 5.0%±1.5% 1 year postoperatively with no statistically difference. Except for C7T1 level, the preoperative anteroposterior diameter and cross section area of spinal canal at C2,3, C3,4, C4,5, C5,6, and C6,7 level were lower than that at 1 year after operation with a significant difference. Except for C2,3 and C7T1 and level, the preoperative anteroposterior diameter and cross section area of spinal cord at C3,4, C4,5, C5,6, and C6,7 level were significantly lower than that at 1 year after operation. The average JOA score preoperatively was 8.9±1.7. The average JOA score at 3 months postoperatively was 13.1±2.0, which was significantly higher than that preoperatively. At 3 months postoperatively, the average improvement rate was 52.0%, and the superior rate was 52.3%. At 1 year postoperatively, the average JOA score was 13.3±2.1, which improved significantly from that preoperatively. The average improvement rate was 54.3%, and the superior rate was 61.9%. The VAS score at preoperatively was 3.0±2.4, and which was 2.7±1.7 at 1 year postoperatively with no significant differences. At pre-operation, the level of Frankel classification was C level in one (4.8%) case, D level in 8 (38.1%) cases and E level in 12 (57.1%) cases. At 1 year postoperatively, the level of Frankel classification was C level in one (4.8%) case, D level in 6 (28.6%) cases and E level in 14 (66.7%) cases, compared with that at preoperatively, there was no statistically significant difference. One patients suffered from neurologic deterioration at 1 year after surgery and recovered after anterior cervical surgery. No other serious complications were occurred. Conclusion For the patients with multi-segmental cervical diseases accompanied cervical lordosis loss, effective spinal decompression by cervical posterior laminoplasty was feasible, and a good clinical efficacy was achieved. Key words: Cervical vertebrae; Spinal stenosis; Spinal cord compression

Isometric Exercise for the Cervical Extensors Can Help Restore Physiological Lordosis and Reduce Neck Pain: A Randomized Controlled Trial.

The aim of this study was to investigate whether isometric neck extension exercise restores physiological cervical lordosis and reduces pain. Sixty-five patients with loss of cervical lordosis were randomly assigned to exercise (27 women, 7 men; mean age, 32.82 ± 8.83 yrs) and control (26 women, 5 men; mean age, 33.48 ± 9.67 yrs) groups. Both groups received nonsteroidal anti-inflammatory drugs for 10 days. The exercise group received additional therapy as a home exercise program, which consisted of isometric neck extension for 3 mos. Neck pain severity and cervical lordosis were measured at baseline and at 3 mos after baseline. Compared with baseline levels, cervical lordosis angle was significantly improved in the exercise group (P < 0.001) but not in the control group (P = 0.371) at the end of 3 mos. Moreover, the exercise group was significantly superior to the control group considering the number of patients in whom cervical lordosis angle returned to physiological conditions (85.2% vs. 22.5%; P < 0.001). At the end of 3 mos, pain intensity was significantly reduced in both groups compared with baseline levels (for all, P < 0.001). Nevertheless, considering the change from baseline to month 3, the reduction in pain was about twice in the exercise group compared with the control group (P < 0.001). Isometric neck extension exercise improves cervical lordosis and pain.

Occipitocervical inclination: new radiographic parameter of neutral occipitocervical position.

To describe occipitocervical inclination (OCI), a new parameter that could compensate for defects in existing radiographic parameters, and to define occipitocervical neutral position. Neutral, flexion, and extension lateral cervical spine radiographs of 200 patients (100 male and 100 female patients) judged to be normal were analyzed. The mean age was 45.19years (range 11-74; 42.84 for male and 47.53 for female patients). For OCI, the angle formed by the line connecting the posterior border of the C4 vertebral body and McGregor's line was measured. Occipitocervical angle (OCA) and occipitocervical distance (OCD) were measured and compared with OCI. OCI on standard, neutral lateral cervical radiographs was 102.51°±8.87°. There was no significant gender difference in neutral OCI 102.81°±7.93° for male and 102.21°±9.74° for female patients (P=0.631). The mean neutral OCA was 38.69°±9.23°, and the mean neutral OCD was 22.98±5.10mm. Pearson's correlation coefficient for the value of the cervical lordosis angle and that of neutral OCI was r=0.274 (P<0.001). Intraclass correlation coefficient values for inter- and intraobserver reliability for OCI were significantly higher than those for OCA (P<0.001) and tended to be higher than those for OCD (P=0.087). OCI is a very useful parameter for the determination of neutral position during occipitocervical fusion for patients with altered C0-C2 anatomy.

MUSCULAR PRESSURE PAIN THRESHOLD AND INFLUENCE OF CRANIOCERVICAL POSTURE IN INDIVIDUALS WITH EPISODIC TENSION-TYPE HEADACHE

ABSTRACT Objective: The objective of this study was to analyze the pressure pain threshold (PPT) of the sternocleidomastoid (SCM), suboccipital (SO) and upper trapezius (UT) muscles and the craniocervical posture in individuals with episodic tension-type headache (ETTH). Methods: This study was a cross-sectional, non-randomized study with 60 young adults (77% female) comprising both sexes and an age range of 18-27 years. Individuals were distributed into a control group (G1) and individuals with ETTH (G2). The frequency of headaches per month was recorded. A pressure dynamometer was used to evaluate the PPT. Photogrammetry was used to evaluate the cervical lordosis (CL) and cephalic protrusion (CP). The data were statistically analyzed. Results: There were differences in the PPT, where the UT, SO and SCM muscles presented lower sensitivity to pain, respectively. The SCM muscle presented a lower PPT in G2. The CL and CP angles were significantly lower in G2. Conclusion: Individuals with ETTH exhibited a significantly lower PPT in the SCM and SO muscles than in the UT muscle. Nevertheless, individuals with ETTH presented with the SCM muscle being more sensitive to pain as well as higher CL and CP than individuals without symptomatology.

The evaluation of cervical spinal angle in patients with acute and chronic neck pain.

Clinicians associate the changes in cervical lordosis with neck pain, but there is no clear consensus on this. We aimed to investigate the relationships of cervical angles, neck pain, disability, and the psychological status of the patients with acute and chronic neck pain. A total of 110 patients with neck pain were included in this study. Demographic and clinical characteristics of the patients were recorded. The lordosis angle was determined by the posterior tangent method. A visual analog scale (VAS), the Neck Disability Index (NDI), and the Hospital Anxiety and Depression (HAD) scale were administered to all patients. The mean cervical lordosis angle was 23.10 ± 8.07 degrees. A statistically negative correlation was detected between cervical angle and duration of disease (P < 0.05). The cervical angle of the acute neck pain group was higher than that of the chronic pain group (P < 0.05). There was no difference between the acute and chronic neck pain groups with respect to VAS, NDI, and HAD scores (P > 0.05). We found that the cervical angle was significantly lower in chronic neck pain patients when compared to acute patients, and patients with higher pain scores had more severe disability and that disability increased with the duration of disease.