The Effect of Cervical Lordosis on Cervical Disc Degeneration in Patients with a High T1 Slope

STUDY DESIGN: Retrospective evaluation. OBJECTIVES: To analyze the effect of cervical lordosis on cervical disc degeneration in patients with a high T1 slope. SUMMARY OF LITERATURE REVIEW: The T1 slope is known to be a parameter that may be very useful in evaluating sagittal balance. We previously reported that a low T1 slope was a potential risk factor for cervical spondylosis, especially in the C6–7 cervical segment. However, no study has analyzed the effect of cervical lordosis in patients with a high T1 slope (>25) on cervical disc degeneration. MATERIALS AND METHODS: Seventy-seven patients with a high T1 slope who underwent cervical spine MRI in our orthopedic clinic were enrolled. Patients were divided into 2 groups according to cervical compensation. The radiologic parameters obtained from radiography and cervical spine MRI were compared between the uncompensated group (cervical lordosis <25) and the compensated group (cervical lordosis ≥25). RESULTS: In the uncompensated group, the average degeneration grade of each segment was 2.72 (±0.70) in C2–3, 3.00 (±0.76) in C3–4, 3.02 (±0.91) in C4–5, 3.37 (±0.95) in C5–6, and 2.95 (±0.98) in C6–7. The average degeneration grade of each segment in the compensated group was 2.38 (±0.78) in C2–3, 2.38 (±0.60) in C3–4, 2.62 (±0.60) in C4–5, 2.82 (±0.72) in C5–6, and 2.41 (±0.74) in C6–7. The degeneration grade was significantly higher in the uncompensated group than in the compensated group for all cervical segments. The risk of high-grade degeneration of C3–4 was significantly higher in the uncompensated group (odds ratio = 6.268; 95% CI, 2.232–17.601; p<.001). CONCLUSIONS: Patients with a high T1 slope without compensation of cervical lordosis had a higher grade of degeneration in all cervical segments.

The effectiveness of seated combined extension-compression and transverse load traction in increasing cervical lordosis- challenging the underlying framework

Introduction: The goal of this study was to assess the effectiveness of seated combined extension- compression and transverse load (ECTL) traction as a new method for increasing a reduced lordosis of less than 30 degrees in a Malaysian population between the ages of 18 and 60 years. Possible changes in disc height were measured in accordance with the underlying theoretical framework, that suggests the anterior cervical structures would elongate due to creep over the fulcrum of the traction device. Method: This was a single centre, randomised, blinded controlled clinical trial with parallel groups, used to test the superiority of the seated combined ECTL traction together with physiotherapy exercises when compared with the same physiotherapy exercises used as a control. Fifty randomly allocated subjects who completed the forty treatments over the fourteen weeks were analysed using non-parametric tests for changes in outcomes. Results: There were no significant changes in outcomes for disc height changes seen in this study. The findings of a greater overall increase in posterior disc height changes compared with anterior disc height changes were in contrast with the proposed underlying theoretical framework for this type of ECTL traction. The greater height changes occurring in the control group were also unexpected. Conclusion: The findings in this study of the contrasting changes in disc height of greater posterior than anterior height changes, question the underlying theoretical framework as postulated for this type of traction.

Late Results of Anterior Cervical Discectomy and Fusion with Interbody Cages

STUDY DESIGN: Retrospective analysis. PURPOSE: To evaluate the effectiveness of anterior cervical discectomy with fusion for degenerative cervical disc disease. OVERVIEW OF LITERATURE: Anterior spinal surgery originated in the mid-1950s and graft for fusion was also employed. Currently anterior cervical microdiscectomy and fusion with an intervertebral cage is a widely accepted procedure for treatment of cervical disc hernia. Artificial grafts and cages for fusion are preferred because of their lower morbidity, reduced operating time and acceptable fusion rate. METHODS: The study involved retrospective analysis and investigation of long-term results for 41 consecutive patients who had undergone anterior cervical discectomy and fusion with an intervertebral cage for cervical disc hernia. The angle of lordosis, segmental height and range of motion were evaluated preoperatively and postoperatively at 1 month and 2 years. The clinical outcome was assessed by the visual analog scale and Odom's criteria. RESULTS: The angle of lordosis increased by 2.62degrees and the range of motion angle increased by 5.14degrees after the operation. The segmental height did not change. The visual analog scale and Odom's criteria scores decreased significantly after the operation. CONCLUSIONS: Using a cage in anterior cervical discectomy prevents segmental collapse, so the segmental height and the angle of lordosis are preserved and newly-developed pain does not occur.

Cervical and Thoracic Sagittal Curves in Thoracic Adolescent Idiopathic Scoliosis / 대한척추외과학회지

STUDY DESIGN: Prospective study OBJECTIVES: To analyze and compare the cervical and thoracic sagittal curves between normal adolescents and patients with thoracic adolescent idiopathic scoliosis (AIS). SUMMARY OF THE LITERATURE REVIEW: There are no reports on cervical sagittal curves and its correlation with thoracic sagittal curves in AIS. MATERIALS AND METHODS: The sagittal curves were analyzed in normal adolescents (N-adol group, n=23) and patients with thoracic AIS (AIS group, n=26) who had thoracic curves > or = 45degrees. Lateral standing radiographs of the cervical spine with a elbow straight and the whole spine with the hands on the clavicles were taken. The sagittal curves and balance were measured in the following segments; C2-C7, T2-T5, T5-12, T2-12, T12-S1. Cervical lordosis (C2-C7) was measured in both cervical spine radiographs and whole spine radiographs. RESULTS: In the N-adol group, the cervical lordosis was 9.2+/-14.6degrees in the cervical spine radiographs and -0.6+/-12.9degrees ('-' means kyphosis) in whole spine radiographs. In the AIS group, cervical lordosis was -5.0+/-12.9degrees in the cervical radiographs and -8.1+/-12.7degrees in the whole radiographs. The AIS group had significantly less cervical lordosis than the N-adol group. Thoracic kyphosis of T5-12 and T2-12 was 24.1+/-10.6degrees and 38.9+/-13.1degrees in the N-adol group, respectively, and 17.8+/-9.4degrees and 30.1+/-11.8degrees in the AIS group, respectively. There was a significant difference between the two groups (Ps0.05). In the AIS group, the cervical lordosis measured in the cervical spine radiograph showed a positive correlation with thoracic kyphosis of T2-5 (r=0.50, P=0.009) and T2-12 (r=0.57, P=0.003). CONCLUSIONS: AIS patients had significantly less cervical lordosis and thoracic kyphosis than normal adolescents. Decreased cervical lordosis in AIS had a significant correlation with their relative thoracic hypokyphosis.

Change of the Lordosis on Cervical Spine after Anterior Interbody Fusion with Autogenous Iliac Strut Bone Graft / 대한척추외과학회지

PURPOSE: Various methods have been used to treat traumas and diseases of the cervical vertebrae. For fractures and diseases of the cervical vertebrae, The authors of this paper sought to evaluate the effectiveness of these different methods by checking for the correction of kyphosis, seeing whether bone graft was successful, making clinical evaluation, and checking for the appropriateness of size and shape of the graft. METHODS: Of the 193 patients who visited the Department of Orthopedics at Chungnam National University Hopspital from January, 1997, to March, 2000, and had operative treatments using the anterior approach or the Smith-Robinson technique, 161 cases that were possible for follow-up were chosen for this study. Among the cases chosen, 111 cases had cervical trauma, and 50 cases had disease of the cervical vertebrae. Simple X-ray was taken to measure the curvature of the affected area and also of the overall cervical curvature(lower end of the second cervical vertebra-lower end of the seventh cervical vertebra), and the healing of the bone was evaluated. RESULTS: Normal range of overall cervical curvature is 16~38 degrees of kyphosis; the curvature after operative treatments for diseased cervical vertebrae was corrected back to the normal range from the reduced angles that existed before the operation. The bone graft was healed in all cases except one(cervical disease), and 15 cases showed prolonged healing. For clinical evaluation using the Robinson scale, 109 cases were excellent, 42 cases were good, and 10 cases were fair. CONCLUSION: Anterior interbody fusion operation of the cervical vertebrae using anterior cervical plate fixation on cases of cervical vertebrate damage and diseases performed, and for the bone graft, using grafts with the anterior surface longer than the posterior surface to induce kyphosis of the cervical vertebrae seemed to be effective. Thus, it is believed that above method is effective in inducing anatomical and functional recovery of patients with trauma and diseases of the cervical vertebrae.