Cervical Lordosis Correction and Segmental Height in Anterior Cervical Surgeries; The Role of Implant Choice.

OBJECTIVES AND BACKGROUND: This study aims to compare the impact of three surgical techniques-stand-alone cage placement (SAC), anterior cervical plate (ACP) fixation, and total disc replacement (TDR)-on cervical lordosis restoration and segmental height after anterior cervical discectomy at C5-6 level. To eliminate the effect of lordosis between different levels, patients operated on at the same level were included in the study. Restoring cervical lordosis is crucial for improving patient outcomes, including pain reduction and preventing mechanical complications. METHODS: A retrospective screening of 89 patients who underwent single-level C5-6 surgery between 2011 and 2021 was analyzed. Patients were categorized into three groups based on the surgical technique used: SAC, ACP, or TDR. Lordotic angles and segmental heights were measured preoperatively, first-month follow-up, and at the 24-month follow-up. Statistical analysis was conducted using the Wilcoxon Signed Rank test and ANOVA, with a significance threshold set at P<.05. RESULTS: All three techniques resulted in significant early and late postoperative increases in both global and segmental lordosis. The early postoperative height gain was most pronounced in the ACP group. However, no significant differences in lordosis or height preservation were observed among the groups at the 24-month follow-up. These findings align with previous studies, indicating comparable long-term outcomes across these surgical approaches. CONCLUSION: Stand-alone cage placement, anterior cervical plate fixation, and total disc replacement all effectively restore cervical lordosis and segmental height after anterior cervical discectomy at the C5-6 level. Despite early differences, the long-term results were similar, suggesting that the choice of technique should be based on individual patient needs and specific surgical considerations.

Improvement in Spine Pain, Functional Performance, and Quality of Life in a 26-Year-Old Male With a Failed Spine Fusion Surgery After Chiropractic BioPhysics® Structural Spinal Rehabilitation: A Case Report With a Six-Month Follow-Up.

Neck pain (NP) is a leading cause of disability and can be a consequence of failed cervical spine surgeries. Articles showing successful conservative therapies after a failed surgery in the cervical spine are very rare. A 26-year-old male reported six years of worsening and disabling NP. The short-form 36-question health status questionnaire revealed a decrease in quality-of-life scores, with a physical component score (PCS) of 25.2 and a mental component score (MCS) of 29.9, compared to the normal scores of 46.8 and 52.8, respectively. Grip strength measured 36.7 kg on the left and 37.1 kg on the right (normal range: 45-52 kg). Radiography revealed cervical hypolordosis (absolute rotation angle, ARA, C2-C7) and anterior head translation (Tz C2-C7) measuring -14.6° and 20.6 mm (ideal is -42° and 0 mm). Chiropractic BioPhysics® (CBP®) (CBP Non-Profit, Inc., Eagle, ID) spinal rehabilitation sessions were administered involving Mirror Image® (CBP Non-Profit, Inc.) spinal exercises, traction, and adjustments to correct cervical spinal alignment. Following 30 treatments over nine weeks, the patient reported near-resolution of initial symptoms, discontinued pain medications, and improved quality of life. Posttreatment outcomes included the following: improvement in PCS (45.6) and MCS (37.1), normalized grip strength on the left (45.3 kg) and right (49.4 kg), and improvement in ARA C2-C7 (30.1°) and Tz C2-C7 (15.6 mm). After six months without treatment, a follow-up examination showed sustained improvements in symptoms and outcome measures, including ARA C2-C7 (30.9°) and Tz C2-C7 (10.6 mm). Failed cervical spine surgeries and persistent spine pain syndrome can occur with devastating consequences. CBP® may be an effective, conservative approach to help improve pain and disability in patients with poor surgical outcomes and abnormal spinal alignment.

The Reduction of Cervical Hyperlordosis and Resolution of Craniocervical Symptoms in an Adolescent Female: A Chiropractic Biophysics Case Report With Long-Term Follow-Up.

Cervical hyperlordosis is a rare condition in the pediatric population. We present a unique case of the application of Chiropractic Biophysics® (CBP®) technique protocols to reduce a hyperlordotic cervical spine corresponding with many craniocervical symptoms, including chronic migraines and neck pain. A 15-year-old female presented with chronic headaches, neck pain, and neck stiffness among other complaints following a martial arts sprain injury several months prior. There were many positive orthopedic tests and limited range of motion. Radiographs revealed a cervical hyperlordosis and a right lateral head translation. CBP® treatment was given and involved cervical distraction traction as well as corrective exercises twice a week for 12 weeks, and then monthly for one year with a complementary home program. After 12 weeks, there was a full recovery from migraines and neck pain correlating with an 8° reduction in lordosis and correction of head translation. At 15 months, the patient remained well and achieved a 13° total reduction in the neck curve. This is the first case documenting the successful application of CBP® methods to reduce cervical spine hyperlordosis in peer-reviewed literature. We propose too much curve may be as detrimental as too little curve in the cervical spine with respect to causing adverse stresses and strains in the surrounding soft tissues leading to pathological processes and nociceptive tendencies.

Resolution of Chronic Migraine Headaches and Improvement in Cervical Spine Kyphosis Following Chiropractic BioPhysics® (CBP®) Treatment: A Case Report With a Seven-Month Follow-Up.

We present a chronic migraine (CM) patient demonstrating significant improvement in subjective and objective reported outcome measures with deeper cervical lordosis parameters and reduced forward head posture on radiographs. A 29-year-old male suffered from CM reporting significant pain and disability with aural, sensory, and motor disturbances during the migraine headaches. Aura with visual disturbances, abnormal facial and extremity sensation, sporadic motor weakness, and other signs of CM were found in the patient's history since age 10. The patient reported previous physical therapy, manual chiropractic, and over-the-counter medications. Migraine-specific prescriptions without long-term reduction in pain and disability were reported. The pain and suffering had been reported to be worsening, and he sought Chiropractic BioPhysics® (CBP®) spine and postural rehabilitation protocols. These protocols were used to increase cervical lordosis, reduce coronal imbalances, increase mobility, and create better posture. These protocols include specific prescriptions based on radiography for postural exercises, postural mirror image® (MI®)traction, and specific spinal manipulative therapy (SMT) focused on posture. All outcome measures improved with the resolution of all initial symptoms of CM. There was a 16° improvement in cervical lordosis, a 30% decrease in headache disability, and additional improvements. These improvements were maintained at a seven-month follow-up during which the patient received infrequent maintenance treatments. This successful treatment of a patient with CM with long-term follow-up adds to evidence that CBP® spinal structural rehabilitation may prove effective and serve as a possible tool for clinicians, physicians, and therapists to treat CM.

Reducing Chronic Spine Pain in an Adult Male by Decreasing Lumbar Scoliosis and Increasing Cervical Lordosis Using Chiropractic BioPhysics® Protocols: A 26-Month Follow-Up Case Report.

We present a case report of a patient suffering from chronic low back pain (CLBP) and chronic non-specific neck pain (CNSNP), both of which were caused and complicated by a physically demanding occupation, a history of mixed martial arts, and lumbar scoliosis. Improvements in patient-reported outcomes (PROs) and radiographic findings were observed following conservative spine rehabilitation. The patient, a 34-year-old male, had experienced chronic spine pain, particularly CLBP and CNSNP, for several years. He reported severe pain and increasing disability after a recent neck injury sustained while practicing jiu-jitsu. Radicular pain, along with numbness and tingling, was noted in the right upper extremity, extending to the first three digits, and there were also altered sensations and temperature changes in both feet. He described sharp, pinching mid-back pain and worsening disability due to the persistent pain, which led him to seek manual manipulative chiropractic spine therapy, though he reported little benefit from it. The patient had relied on over-the-counter pain medications for many years without achieving long-term pain and disability relief, and these medications were no longer used following treatment. Chiropractic BioPhysics® (CBP®) spinal structural rehabilitation protocols were used to improve coronal and sagittal balance, as well as paraspinal muscular strength, addressing posture, mobility, and related aspects. These protocols include postural exercises, postural Mirror Image® traction, and postural spinal manipulative therapy. All PROs improved, with a near resolution of all initial symptoms of chronic spine pain. Outcomes measured included disability indices and health-related quality of life (HRQoL) indicators. Radiographic parameter improvements were significant, demonstrating improved coronal and sagittal balance as a result of the treatment. Following 30 in-office treatments, administered three times per week for 10 weeks, initial outcomes were reassessed. The patient then received 13 in-office treatments periodically over one year, and all initial outcomes were repeated. The improvements remained stable over time. A 26-month follow-up found that the improvements were sustained over a very long period without additional treatment after the 13-month examination. Chronic spine pain, specifically CLBP and CNSNP, is a significant source of suffering and contributes substantially to the global burden of disease. Improvement in HRQoLs, PROs, and objective spine parameters are desirable clinical outcomes. Our case report documents objective improvement in lumbar scoliosis and spine pain, which is rare in conservative studies. This successful treatment of chronic pain with long-term follow-up contributes to the growing evidence supporting conservative, non-surgical treatments for CNSNP and CLBP. Successful management of chronic spine pain was observed in a patient undergoing CBP® treatment. The treatment was designed to address abnormal sagittal and coronal postural balance and radiographic abnormalities indicating spinal misalignment and reassess progress in PROs, as well as objective and subjective HRQoL measures, both following treatment and 13 months later. However, larger studies are needed to draw firm conclusions regarding the efficacy of this treatment for chronic pain.

Laminoplasty with foraminotomy versus anterior cervical discectomy and fusion for cervical myeloradiculopathy.

BACKGROUND CONTEXT: Anterior cervical discectomy and fusion (ACDF) combined with uncinate process resection and laminoplasty combined with foraminotomy (LPF) have been used to achieve cervical cord and root decompression in patients with combined cervical myeloradiculopathy (CMR). PURPOSE: To compare the clinical and radiographic outcomes of ACDF with those of LPF for the treatment of CMR. STUDY DESIGN/SETTING: Propensity score-matched retrospective cohort study. PATIENT SAMPLE: Patients with CMR who underwent ACDF or LPF and were followed up for at least 2 years. OUTCOME MEASURES: C2-C7 lordosis, C2-C7 sagittal vertical axis, and cervical range of motion (ROM) were determined. The visual analog scale (VAS) scores for neck and arm pain, neck disability index (NDI), and Japanese Orthopedic Association (JOA) scores were analyzed. METHODS: The radiographic and clinical outcomes of the 2 groups were compared. RESULTS: Eighty-four patients were included (n=42 in each group) after application of the inclusion criteria and propensity score matching. A significant decrease in C2-C7 lordosis (p<.001) and ROM (p<.001) was observed in the LPF and ACDF groups, respectively. LPF was associated with a significant decrease in C2 to C7 lordosis (p<.001), while ACDF caused a significant decrease in cervical ROM (p<.001). ACDF effectively improved neck pain VAS (p<.001) and NDI (p<.001), while neck pain did not significantly improve after LPF (p=.103). Furthermore, neck pain VAS (p=0.026) and NDI (p=.021) at postoperative 6 months, were significantly greater in the LPF group than in the ACDF group, while the difference was not statistically significant at 2 years postoperatively (neck pain VAS, p=.502; NDI, p=.085). Arm pain VAS and JOA score both significantly improved after LPF (p=0.003 and 0.043, respectively) or ACDF (p<.001 and 0.039, respectively), and postoperative results were not significantly different between the 2 groups. CONCLUSION: LPF and ACDF yielded similar outcomes for arm pain and neurological recovery. More immediate neck pain improvement was observed with ACDF, while neck pain after 2 years postoperatively was similar between the LPF and ACDF groups. Furthermore, increased postoperative loss of lordosis was observed in the LPF group, whereas decreased postoperative ROM was observed in the ACDF group. These findings should be considered when deciding the surgical method for patients with CMR. LEVEL OF EVIDENCE: III.

Is cervical sagittal alignment associated with pain and disability in myofascial pain syndrome?: A cross-sectional study.

OBJECTIVE: To elucidate the role of cervical sagittal alignment in the pathophysiology of cervical myofascial pain syndrome(MFPS) and its impact on pain levels and disability status among patients. METHODS: This prospective cross-sectional study included participants aged 18-64 years experiencing neck pain for more than 3 months and diagnosed with MFPS. Cervical sagittal parameters (C0-2 cervical lordosis(CL) angle, C2-7 CL angle, cervical sagittal vertical axis (cSVA), T1 slope, T1 slope minus CL mismatch(T1S-CL), and cervical tilt) were measured using Surgimap software by an expert physiatrist. Pain levels were assessed using the Numerical Pain Rating Scale(NRS), and neck disability was evaluated using the Neck Bournemouth Questionnaire(NBQ). RESULTS: Out of 200 initially assessed participants with cervical MFPS, 133 were included after excluding ineligible individuals. The mean age of the participants was 35.3±8.2 years. Participants categorized by pain severity (moderate vs. severe) showed no significant differences in cervical range of motion, C0-2 angle, cSVA, T1 slope and T1S-CL. However, significant differences were observed in C2-7 angle (p=0.008), cervical tilt (p=0.006), and NBQ scores (p<0.001) between the two pain severity groups. Grouping based on T1S-CL compliance showed no significant differences in pain and disability effects. Correlation analysis revealed weak negative correlations between pain levels and C2-7 Cobb angle (p=0.009, r=0.226) as well as cervical tilt (p=0.005, r=0.243). No correlations were found between cervical sagittal parameters and NBQ scores. CONCLUSIONS: Decreased C2-7 CL angle and cervical tilt angle are associated with increased pain levels; however, cervical sagittal alignment was not found to be associated with disability.

Resolution of Sporadic Hemiplegic Migraine by Correcting a Cervical Spine Kyphosis Utilizing the Chiropractic BioPhysics® (CBP®) Technique: A Case Report With Long-Term Follow-Up.

A 19-year-old male suffered from sporadic hemiplegic migraine (SHM) for several years and experienced significant pain and disability with sensory and motor disturbances during the migraine headaches. Weakness, abnormal vision, abnormal sensation, one-sided disabling motor weakness, and other signs of SHM were diagnosed. The patient had received previous physical therapy, chiropractic and over-the-counter medications, as well as migraine-specific prescriptions without lasting improvements. Chiropractic BioPhysics® (CBP®) spinal structural rehabilitation protocols were used to increase cervical lordosis and improve cervical muscular strength, mobility, and posture. These protocols include spine-specific prescriptions for Mirror Image® postural exercises, traction, and spinal manipulative therapy. After 24 treatments over eight weeks, all subjective and objective outcomes improved dramatically with a near resolution of all initial symptoms of SHM. There were a significant increase in cervical lordosis and a reduction in forward head posture. The neck disability index improved from 26% to 6%, and all pain scores for all regions improved following treatment. A 10-month follow-up exam showed the outcomes were maintained. SHM is rare and debilitating, is part of the global burden of disease, and is a major cause of disability in the world. Reports of successful conservative and non-conservative long-term treatments for SHM are rare, and there are no clinical trials showing successful treatments for SHM. This successful case demonstrates preliminary evidence that CBP spinal structural rehabilitation may serve as a treatment option for SHM. Future studies are needed to replicate the findings from this case.

Analyzing results of cervical sagittal parameters in patients operated with polyetheretherketone cages without plate.

Study Design: This was a retrospective longitudinal observational study. Purpose: The purpose of this study was to analyze the results of cervical sagittal parameters on preoperative and postoperative lateral radiographs in anterior cervical discectomy and fusion (ACDF). ACDF is believed to change craniocervical parameters and thus cervical curvature using polyetheretherketone (PEEK) or titanium cages with or without self-locking as well as an anterior plate, the latter of which has not been shown to provide better clinical or radiological results. Overview of Literature: Cervical spondylotic myelopathy (CSM) is a common degenerative pathology that can affect one or more levels and treatment has varied over time trying to maintain sagittal parameters within acceptable values where the ACDF is the main treatment. Materials and Methods: The study was performed in patients with CSM who underwent anterior cervical discectomy, and their pre- and postoperative radiographs were analyzed using Surgimap software a few days before and 3 months after surgery. Results: Fifteen files were included in the study. Statistically significant sagittal balance variables were observed in cervical lordosis (CL) with an increase of 4.73° (P = 0.019) and T1 slope (T1S)-CL with a decrease of -5.93° (P = 0.007). Conclusions: CL and T1S-CL showed favorably modified values when performing ACDF using stand-alone PEEK cages without the need for self-blocking or an anterior plate.

Sagittal Full-Spine vs. Sectional Cervical Lateral Radiographs: Are the Measurements of Cervical Alignment Interchangeable?

(1) Background: This study assessed the relationship between cervical spine parameters taken on standing full-spine lateral radiographic images compared to sectional lateral cervical radiographs. (2) Methods: Full-spine (FS) and sectional lateral cervical (LC) radiographs from four spine treatment facilities across the USA retrospectively provided data collected on 220 persons to assess the comparison of three sagittal cervical radiographic measurements between the two views. The measures included cervical lordosis using the absolute rotation angle from C2-C7, sagittal cervical translation of C2-C7, and atlas plane angle to horizontal. Linear correlation and R2 models were used for statistical comparison of the measures for the two views. (3) Results: The mean values of the three measurements were statistically different from each other: C2-C7 translation (FS = 19.84 ± 11.98 vs. LC = 21.18 ± 11.8), C2-C7 lordosis (FS = -15.3 ± 14.63 vs. LC = -18.32 ± 13.16), and atlas plane (FS = -19.99 ± 8.88 vs. LC = -22.56 ± 8.93), where all values were p < 0.001. Weak-to-moderate-to-strong correlations existed between the full-spine and sectional lateral cervical radiographic variables. The R2 values varied based on the measurement were R2 = 0.768 (p < 0.001) for sagittal cervical translation of C2-C7 (strong), R2 = 0.613 (p < 0.001) for the absolute rotation angle C2-C7 (moderate), and R2 = 0.406 (p < 0.001) for the atlas plane line (weak). Though a linear correlation was identified, there were consistent intra-person differences between the measurements on the full spine versus sectional lateral cervical radiographic views, where the full-spine view consistently underestimated the magnitude of the variables. (4) Conclusion: Key sagittal cervical radiographic measurements on the full spine versus sectional lateral cervical radiographic views show striking intra-person differences. The findings of this study confirm that full spine versus sectional lateral cervical radiographic views provide different biomechanical magnitudes of cervical sagittal alignment, and caution should be exercised by health care providers as these are not interchangeable. We recommend the LC view for measurement of cervical sagittal alignment variables.

Intra-Examiner Reliability and Validity of Sagittal Cervical Spine Mensuration Methods Using Deep Convolutional Neural Networks.

Background: The biomechanical analysis of spine and postural misalignments is important for surgical and non-surgical treatment of spinal pain. We investigated the examiner reliability of sagittal cervical alignment variables compared to the reliability and concurrent validity of computer vision algorithms used in the PostureRay® software 2024. Methods: A retrospective database of 254 lateral cervical radiographs of patients between the ages of 11 and 86 is studied. The radiographs include clearly visualized C1-C7 vertebrae that were evaluated by a human using the software. To evaluate examiner reliability and the concurrent validity of the trained CNN performance, two blinded trials of radiographic digitization were performed by an extensively trained expert user (US) clinician with a two-week interval between trials. Then, the same clinician used the trained CNN twice to reproduce the same measures within a 2-week interval on the same 254 radiographs. Measured variables included segmental angles as relative rotation angles (RRA) C1-C7, Cobb angles C2-C7, relative segmental translations (RT) C1-C7, anterior translation C2-C7, and absolute rotation angle (ARA) C2-C7. Data were remotely extracted from the examiner's PostureRay® system for data collection and sorted based on gender and stratification of degenerative changes. Reliability was assessed via intra-class correlations (ICC), root mean squared error (RMSE), and R2 values. Results: In comparing repeated measures of the CNN network to itself, perfect reliability was found for the ICC (1.0), RMSE (0), and R2 (1). The reliability of the trained expert US was in the excellent range for all variables, where 12/18 variables had ICCs ≥ 0.9 and 6/18 variables were 0.84 ≤ ICCs ≤ 0.89. Similarly, for the expert US, all R2 values were in the excellent range (R2 ≥ 0.7), and all RMSEs were small, being 0.42 ≤ RMSEs ≤ 3.27. Construct validity between the expert US and the CNN network was found to be in the excellent range with 18/18 ICCs in the excellent range (ICCs ≥ 0.8), 16/18 R2 values in the strong to excellent range (R2 ≥ 0.7), and 2/18 in the good to moderate range (R2 RT C6/C7 = 0.57 and R2 Cobb C6/C7 = 0.64. The RMSEs for expert US vs. the CNN network were small, being 0.37 ≤ RMSEs ≤ 2.89. Conclusions: A comparison of repeated measures within the computer vision CNN network and expert human found exceptional reliability and excellent construct validity when comparing the computer vision to the human observer.

Abnormal Static Sagittal Cervical Curvatures following Motor Vehicle Collisions: A Retrospective Case Series of 41 Patients before and after a Crash Exposure.

Previous investigations have found a correlation between abnormal curvatures and a variety of patient complaints such as cervical pain and disability. However, no study has shown that loss of the cervical curve is a direct result of exposure to a motor vehicle collision (MVC). This investigation presents a retrospective consecutive case series of patients with both a pre-injury cervical lateral radiograph (CLR) and a post-injury CLR after exposure to an MVC. Computer analysis of digitized vertebral body corners on CLRs was performed to investigate the possible alterations in the geometric alignment of the sagittal cervical curve. METHODS: Three spine clinic records were reviewed over a 2-year period, looking for patients where both an initial lateral cervical X-ray and an examination were performed prior to the patient being exposed to a MVC; afterwards, an additional exam and radiographic analysis were obtained. A total of 41 patients met the inclusion criteria. Examination records of pain intensity on numerical pain rating scores (NPRS) and neck disability index (NDI), if available, were analyzed. The CLRs were digitized and modeled in the sagittal plane using curve fitting and the least squares error approach. Radiographic variables included total cervical curve (ARA C2-C7), Chamberlain's line to horizontal (skull flexion), horizontal translation of C2 relative to C7, segmental translations (retrolisthesis and anterolisthesis), and circular modelling radii. RESULTS: There were 15 males and 26 females with an age range of 8-65 years. Most participants were drivers (28) involved in rear-end impacts (30). The pre-injury NPRS was 2.7 while the post injury was 5.0; p < 0.001. The NDI was available on 24/41 (58.5%) patients and increased after the MVC from 15.7% to 32.8%, p < 0.001. An altered cervical curvature was identified following exposure to MVC, characterized by an increase in the mean radius of curvature (265.5 vs. 555.5, p < 0.001) and an approximate 8° reduction of lordosis from C2-C7; p < 0.001. The mid-cervical spine (C3-C5) showed the greatest curve reduction with an averaged localized mild kyphosis at these levels. Four participants (10%) developed segmental translations that were just below the threshold of instability, segmental translations < 3.5 mm. CONCLUSIONS: The post-exposure MVC cervical curvature was characterized by an increase in radius of curvature, an approximate 8° reduction in C2-C7 lordosis, a mild kyphosis of the mid-cervical spine, and a slight increase in anterior translation of C2-C7 sagittal balance. The modelling result indicates that the post-MVC cervical sagittal alignment approximates a second-order buckling alignment, indicating a significant alteration in curve geometry. Future biomechanics experiments and clinical investigations are needed to confirm these findings.

Greater cervical kyphosis during flexion increases the risk of kyphotic deformity after laminoplasty in patients with cervical spondylotic myelopathy.

Kyphotic deformity following the loss of cervical lordosis can lead to unfavourable neurological recovery after cervical laminoplasty (CLP); therefore, it is essential to identify its risk factors. Recent studies have demonstrated that the dynamic parameters of the cervical spine, based on baseline flexion/extension radiographs, are highly useful to estimate the loss of cervical lordosis after CLP. However, it remains unclear whether such dynamic parameters can predict kyphotic deformity development after CLP. Hence, the present study aimed to investigate whether the dynamic parameters could predict kyphotic deformity in patients with cervical spondylotic myelopathy (CSM) after CLP. This retrospective study included 165 patients, consisting of 10 and 155 patients with and without cervical kyphosis of C2-C7 angle ≤ -10° at the final follow-up period, respectively. Among the static and dynamic parameters of the cervical spine, greater cervical kyphosis during flexion (fC2-C7 angle) demonstrated the best discrimination between these two cohorts, with an optimal cutoff value of -27.5°. Meanwhile, greater gap range of motion (gROM = flexion ROM - extension ROM ) had the highest ability to predict a loss of ≥ 10° in C2-C7 angle after CLP, with an optimal cutoff value of 28.5°. This study suggests that in patients with CSM, fC2-C7 angle ≤ -25° on baseline radiographs is a potential risk for kyphotic deformity after CLP. In clinical practice, the patients with this criterion (fC2-C7 angle ≤ -25°) along with gROM ≥ 30° are at high risk of developing significant kyphotic deformity after CLP.

Upper and lower cervical alignment parameters measured on supine magnetic resonance imaging with the occipital slope as a key marker of cervical alignment.

Objectives: Cervical spine alignment is evaluated by measuring the cervical angles or parameters on standing plain radiography. In this study, we aimed to evaluate mainly the upper cervical alignment and the correlation between upper and lower cervical sagittal parameters measured on supine magnetic resonance imaging (MRI). Materials and Methods: Cervical MRIs of 210 outpatients were reviewed to measure the upper and lower cervical sagittal parameters. Their mean values were compared with normative values measured on standing X-ray from the literature. Correlations between the parameters were analyzed using the Pearson's correlation coefficient. Results: The C0 slope was correlated with all other parameters, except for the C2-7 sagittal vertical axis. The strongest correlations (r > 0.500) were between the CL and C2 slope, between the CO2 and C0 slope, and between the C2 slope and C0 slope. Conclusion: On supine MRI, the C0 slope is a key marker of cervical spinal alignment. A strong correlation was observed between the C2 slope and C0 slope; therefore, the relationship between upper and lower cervical alignment could be assessed using slopes on MRI.

[Influence of preoperative symptom duration on effectiveness of cervical disc arthroplasty in cervical spondylotic radiculopathy patients].

Objective: To investigate the influence of preoperative symptom duration on effectiveness of cervical disc arthroplasty (CDA) in cervical spondylotic radiculopathy (CSR) patients. Methods: The clinical data of 90 CSR patients who underwent single-segment CDA between January 2008 and March 2020 and met the selection criteria were retrospectively analyzed. Based on preoperative symptom duration, patients were divided into an early intervention group (preoperative symptom duration <24 months) and a late intervention group (preoperative symptom duration ≥24 months). There was no significant difference in baseline data between the two groups ( P>0.05), including age, gender, body mass index, smoking status, surgical segment, preoperative neck disability index (NDI), visual analogue scale (VAS) score, cervical lordosis (CL), C 2-C 7 range of motion (ROM), disc angle (DA), disc ROM (DROM), and disc intervertebral height (DIH). The early intervention group had a slightly higher preoperative Japan Orthopedic Association (JOA) score than the late intervention group ( P<0.05). Perioperative indicators such as operation time, intraoperative blood loss, and postoperative hospital stay were recorded. The changes of JOA score, NDI, and VAS score at last follow-up compared with those before operation were used to evaluate the clinical efficacy, and the imaging evaluation of CL, C 2-C 7 ROM, DA, DROM, and DIH was performed before operation, immediately after operation, and at last follow-up. The incidence of prosthesis-related complications, including heterotopic ossification (HO), anterior bone loss (ABL), and prosthesis subsidence, was also assessed at last follow-up. Results: Patients in both groups were followed up 24-120 months, with an average of 53.4 months. There was no significant difference in operation time, intraoperative blood loss, or follow-up duration between the groups ( P>0.05). However, the late intervention group had significantly longer postoperative hospital stay compared to the early intervention group ( P<0.05). At last follow-up, there was no significant difference in the changes of JOA score, NDI, and VAS score between the two groups before and after operation ( P>0.05). During the follow-up, there was no surgical revision in the two groups, and there was no significant difference in the incidence of HO, ABL, and prosthesis subsidence between the two groups at last follow-up ( P>0.05). Imaging evaluation showed that there was no significant difference in CL, C 2-C 7 ROM, DA, DROM, and DIH between the two groups at each time point before and after operation ( P>0.05). The intra-group comparison showed that the early intervention group could maintain the immediate postoperative CL at last follow-up, while the late intervention group had recovered to the preoperative level. Additionally, the C 2-C 7 ROM, DROM, and DA had all recovered to preoperative levels at last follow-up in both groups; meanwhile, the DIH significantly increased immediately after operation and sustained until the last follow-up. Conclusion: Preoperative symptom duration significantly affects the effectiveness of CDA in CSR patients. Patients with preoperative symptom duration ≥24 months have longer postoperative hospital stays and potentially poorer ability to maintain CL compared with patients with preoperative symptom duration <24 months.

What Happens to Sagittal Alignment Following Laminoplasty Versus Laminectomy and Fusion?

OBJECTIVE: Laminectomy and fusion (LF) and laminoplasty (LP) are 2 sucessful posterior decompression techniques for cervical myelo-radiculopathy. There is also a growing body of evidence describing the importance of cervical sagittal alignment (CSA) and its importance in outcomes. We investigated the difference between pre- and postoperative CSA parameters in and between LF or LP. Furthermore, we studied predictive variables associated with change in cervical mismatch (CM). METHODS: This is a retrospective cohort study of adults with cervical myeloradiculopathy in a single healthcare system. The primary outcomes are intra- and inter-cohort comparison of LF versus LP radiographic parameters at pre- and postoperative time points. A secondary multivariable analysis of predictive factors was performed evaluating factors predicting postoperative CM. RESULTS: Eighty nine patients were included; 38 (43%) had LF and 51 (57%) underwent LP. Both groups decreased in lordosis (LF 11.4° vs. 4.9°, P = 0.01; LP 15.2° vs. 9.1°, P < 0.001), increased in cSVA (LF 3.4 vs. 4.2 cm, P = 0.01; LP 3.2 vs. 4.2 cm, P < 0.001), and increased in CM (LF 22.0° vs. 28.5°, P = 0.02; LP 16.8° vs. 22.3°, P = 0.002). There were no significant differences in the postoperative CSA between groups. No significant predictors of change in pre- and postoperative CM were found. CONSLUSIONS: There were no significant pre-or postoperative differences following the 2 procedures, suggesting radiographic equipoise in well indicated patients. Across all groups, lordosis decreased, cSVA increased, and cervical mismatch increased. There were no predictive factors that led to change in cervical mismatch.

Comparison of muscle energy technique and facet joint mobilisation in the patient with chronic neck pain: A randomized controlled trial.

OBJECTIVE: To compare the effects of muscle energy techniques, facet joint mobilisation and conventional physical therapy on pain, disability, cervical lordosis and range of motion in patients with chronic neck pain. METHODS: The parallel-design randomised controlled trial was conducted at the Physical Therapy and Rehabilitation Department of the Heavy Industries Taxila Hospital, Taxila Cantt, Pakistan, from December 2020 to May 2021, and comprised patients of either gender aged 35-50 years who had chronic neck pain, recurrent neck pain, and cervical spine curve. The participants were randomised into muscle energy techniques group A, facet joint mobilisation group B and conventional physical therapy group C. The outcome measures were cervical lordosis, pain intensity, neck disability index and cervical range of motions. Data was analysed using SPSS 21. RESULTS: Of the 115 patients initially assessed, 105(91.3%) were included; 67(63.8%) females and 38(36.2%) males. There were 35(33.3%) subjects in group A with mean age 40.09± 4.29 years, 35(33.3%) in group B with mean age 40.14±4.57 years and 35(33.3%) in group C with men age 39.26±5.19 years. There were no significant differences among the groups at baseline in terms of mean age, weight, height, body mass index, neck disability index, cervical lordosis and range of motion (p>0.05). Of the total, 6(5.7%) were lost to follow-up and the study was completed by 99(94.3%) subjects. Outcome variables in group A were superior to those in groups B and C with respect to flexion, rotation and side-bending (p<0.05). There was no significant difference between groups A and B related to numeric pain rating scale and neck disability index (p>0.05). CONCLUSIONS: Muscle energy techniques and facet joint mobilisation showed significant improvement in neck pain, disability and cervical range of motions compared to conventional physical therapy. Muscle energy techniques and facet joint mobilisation produced similar outcomes with respect to pain intensity and functional disability. Clinical Trial Number: The study was prospectively registered with clinicaltrials.gov (NCT05040477).

Early radiographic outcomes after anterior cervical discectomy and fusion with anatomic versus lordotic cages.

Background: Anterior cervical discectomy and fusion (ACDF) interbody implants are shaped anatomically, with a convex superior aspect, or lordotically, with an angle and flat surfaces. However, the effect of implant shape on cervical sagittal balance (CSB) is not well described. Methods: Of the 192 cases reviewed from 2018 to 2019, 118 were included with matching pre- and postoperative imaging. Cases were categorized by interbody implant type (anatomic or lordotic) and number of levels fused (1-level, 2-level, etc.). SurgiMap was used to measure cervical lordosis (CL), C2-C7 sagittal vertical axis (cSVA), T1 slope (T1S), and T1S minus CL (T1S-CL) on pre- and postoperative imaging. Pre- and postoperative parameters were compared within and between each cohort. Change in CL (ΔCL), cSVA (ΔcSVA), and T1S-CL (ΔT1S-CL) were calculated as the difference between pre- and postoperative values and were compared accordingly (1) anatomic versus lordotic and (2) 1-level versus 2-level versus 3-level fusion. Results: Thirty-nine (33.1%), 57 (48.3%), and 22 (18.6%) cases comprised the anatomic, lordotic, and mixed (anatomic and lordotic) groups, respectively. ACDFs improved CL and T1S-CL by 5.71° (p<.001) and 3.32° (p<.01), respectively. CL was improved in the lordotic (5.27°; p<.01) and anatomic (4.57°; p<.01) groups, while only the lordotic group demonstrated improvement in T1S-CL (3.4°; p=.02). There were no differences in ΔCL (p=.70), ΔcSVA (p=.89), or ΔT1S-CL (p=.1) between the groups. Two- and 3-level fusions improved CL by 7.48° (p<.01) and 9.62° (p<.01), and T1S-CL by 4.43° (p<.01) and 5.96° (p<.01), respectively. Conclusions: Overall, ACDFs significantly improved CL and T1S-CL however, there were no differences in CSB correction between the anatomic and lordotic groups. Two- and 3-level fusions more effectively improved CL (vs. single-level) and T1S-CL (vs. 3-level). These results suggest that implants should continue to be personalized to the patient's anatomy, however, future research is needed to validate these findings and incorporate the effects of preoperative deformities.

Effect of long-term cervical extensor exercise program on functional disability, pain intensity, range of motion, cervical muscle mass, and cervical curvature in young adult population with chronic non-specific neck pain: a randomized controlled trial.

BACKGROUND: The prevalence of chronic non-specific neck pain (CNNP) is on the rise among the young adult population. We herein aimed to compare the effects of long-term specific cervical extensor training and stretching exercises on improving this chronic disorder in young adults. METHODS: In this prospective, randomized, controlled study, 70 participants aged 18-35 years with CNNP and cervical lordosis loss were included. The participants were assigned to undergo either specific cervical extensor training (observation group) or perform usual stretching exercises (control group). The exercise duration was set at 12 months, with 9 months at the clinic and 3 months at home. The outcome assessments included changes in the neck disability index, visual analog scale from baseline, cervical range of motion (CROM), cross-sectional areas (CSAs) of cervical extensors, and cervical curvature from baseline. The outcome measures were compared between groups at 3, 6, and 12 months of follow-up. RESULTS: All 70 participants underwent randomization, and no significant differences in demographics and baseline data were found between the two groups. The observation group showed a greater improvement in neck disability index and visual analog scale scores at the 12-month follow-up than the control group. Additionally, a more substantial increase in CROM and CSAs of cervical extensors was observed in the observation group at the 6-month and 12-month follow-ups (P < 0.05). Although more participants in the observation group achieved cervical lordosis at the 12-month follow-up, the difference was marginally nonsignificant (9% in the control group vs. 28% in the observation group, P = 0.075). CONCLUSIONS: In young adults with CNNP, long-term specific cervical extensor training was associated with a more significant clinically meaningful improvement in disability, pain, and CROM than stretching exercises. The increased CSAs of cervical extensors may potentially contribute to the restoration of cervical lordosis. Trial registration The study is registered at the Chinese domestic clinical trial (ChiCTR2000040009) at Chictr.org. The date of registration: November 18, 2020.

Assessing Range of Motion Gap in Circumferential Surgery for Cervical Myelopathy due to Ossification of the Posterior Longitudinal Ligament.

OBJECTIVE: Only a few studies have investigated the gap range of motion (gROM) in cervical myelopathy or deformity caused by ossification of the posterior longitudinal ligament (OPLL). The aim of this study is to investigate the correlation between the individual gROM and the postoperative clinical outcomes of patients with OPLL. METHODS: Consecutive patients of cervical myelopathy caused by OPLL were analyzed retrospectively. The clinical outcomes were evaluated using Visual Analogue Scale scores of the neck and arm pain and the Japanese Orthopaedic Association scores. Radiologic measurements included flexion ROM (fROM), which was defined as the difference of cervical lordosis in flexion and neutral positions, extension ROM (eROM), defined as the difference between neutral and extension positions, and gROM, defined as the difference between fROM and eROM. Patients were grouped by the values of gROM, and comparisons of all outcomes were made between the groups. RESULTS: A total of 42 patients underwent surgery. The patients with greater gROM did not differ from those with smaller gROM by demographic characteristics. During follow-up (mean 45.8 months), both groups had similar improvements, but the C5 palsy rates were higher in the greater gROM group than in the smaller gROM group (71% and 22%, P < 0.05). CONCLUSIONS: Simultaneous circumferential decompression and fixation is an effective surgical option for patients with cervical myelopathy caused by OPLL. A higher rate of postoperative C5 palsy was observed in the patients with greater gROMs after surgery, although all patients presented with similar clinical improvements.