无症状中国年轻人颈椎矢状位曲度正常值及其与全脊柱平衡的关系

doi:10.19723/j.issn.1671-167X.2022.04.021

Abstract

Abstract:

Objective: To explore the normal distribution of cervical sagittal alignment and the relationship between cervical alignment and global spine balance in asymptomatic young adults. Methods: A cohort of 272 asymptomatic Chinese adults (including 161 males and 111 females, with an average age of (23.2±4.4) years, ranging from 18 to 45 years) were prospectively recruited from November 2011 to December 2014. The C₀-C₂ angle, disk angles from C₂-C₃ to C₆-C₇, vertebral angles from C₃ to C₇, T₁ slope, thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), C₂-C₇ sagittal vertical axis (C₂-C₇SVA), center of gravity of head to C₇SVA (CGH-C₇SVA), C₇-S₁SVA were measured and statistically analyzed. All the subjects were categorized with the Roussouly classification and the cervical morphologies were evaluated as lordotic, straight, sigmoid or kyphotic. Spinal sagittal alignment parameters were compared between different sexes and Roussouly classifications with independent student t test, analysis of variance (ANOVA) or Chi-square test. Correlations between cervical sagittal alignment and global spine sagittal alignment were calculated using the Pearson and Spearman correlation coefficient. Linear regression analysis was performed. Results: Sixty-seven males and 59 females aged from 18 to 30 years old were included in the study. The mean value of C₀-C₇ was 26.0°±12.8°, composed of 15.2°±6.7° for C₀-C₂, 9.1°±12.1° for sum of disk angles from C₂-C₃ to C₆-C₇, and 1.4°±10.2° for sum of vertebral angles from C₃ to C₇. C₂-C₇SVA [(18.6±7.9) mm] and CGH-C₇SVA [(22.9±12.3) mm]were offset ideally by C₇-S₁SVA [(-21.6±31.0) mm]. Males had a larger T₁ slope (P < 0.05) and accordingly, a larger cervical lordosis C₂-C₇ (P < 0.01) and C₀-C₇ angle (P < 0.01) than females. Males had a smaller C₇-S₁SVA (P < 0.01) and accordingly, a smaller CGH-C₇SVA (P=0.165) than females. Significant difference was found between cervical alignment of different Roussouly types (P < 0.01). In general, a larger LL was consistent with a set of larger TK, C₂-C₇angle, C₀-C₇ angle, and vice versa. There was no significant correlation between cervical morphology and the Roussouly classification (Chi-square=10.548, P=0.308). There was significant correlation between cervical alignment and T₁ slope (P < 0.01), TK (P < 0.01). There was significant correlation between adjacent segmental angles from T₁ slope up to C₀-C₂ angle (P < 0.05). Conclusion: Normative values of each vertebral angle and disk angle were established. The cervical lordosis occurred mainly at C₀-C₂ and disk levels, which was influenced by parameters of other parts of the spine, such as T₁ slope, TK and the Roussouly classification. There was significant correlation between adjacent disk angles.

Key words: Cervical spine, Sagittal alignment, Disk angle, Vertebral angle, Global spine balance

CLC Number:

R681.5

Yan-chao TANG,Wen-kui ZHAO,Miao YU,Xiao-guang LIU. Normative values of cervical sagittal alignment according to the whole spine balance: Based on 126 asymptomatic Chinese young adults[J].Journal of Peking University (Health Sciences), 2022, 54(4): 712-718.

Figures/Tables 7

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Parameter and demographics	Female (n=59)	Male (n=67)	P	Total (n=126)
Age/years	21.1±2.4	21.6±2.2	0.294	21.4±2.3
Height/mm	163.2±4.4	175.4±5.5	< 0.001^*	169.7±7.9
Weight/kg	52.7±6.0	66.3±8.3	< 0.001^*	60.0±9.9
BMI	19.8±2.1	21.5±2.1	< 0.001^*	20.7±2.3
Cervical alignment
C₀-C₂/(°)	15.5±7.3	14.9±6.2	0.480	15.2±6.7
C₂-C₃/(°)	1.0±3.3	2.3±3.5	0.034^*	1.7±3.5
C₃/(°)	0.2±3.7	0.9±3.4	0.307	0.6±3.5
C₃-C₄/(°)	1.3±3.7	1.0±3.8	0.662	1.1±3.7
C₄/(°)	-0.9±3.2	0.8±3.6	0.005^#	0.0±3.5
C₄-C₅/(°)	0.4±2.9	1.2±3.9	0.177	0.8±3.5
C₅/(°)	-1.8±3.3	-0.5±3.4	0.027^*	-1.1±3.4
C₅-C₆/(°)	0.9±3.9	1.8±3.3	0.176	1.4±3.6
C₆/(°)	-0.6±3.2	-0.3±3.5	0.601	-0.4±3.3
C₆-C₇/(°)	4.0±3.6	4.2±3.7	0.810	4.1±3.7
C₇/(°)	2.1±2.8	2.6±2.7	0.230	2.4±2.8
C₂-C₇/(°)	6.6±13.1	14.1±13.2	0.002^#	10.6±13.6
C₀-C₇/(°)	22.6±11.1	28.9±13.5	0.006^#	26.0±12.8
T₁ slope/(°)	24.7±7.4	27.4±6.5	0.034^*	26.1±7.0
C₂-C₇SVA/mm	18.9±6.3	18.3±9.1	0.674	18.6±7.9
CGH-C₇SVA/mm	24.5±11.5	21.4±12.9	0.165	22.9±12.3
Whole spine alignment
TK/(°)	24.4±7.2	24.8±7.1	0.779	24.6±7.1
LL/(°)	47.9±9.5	48.1±9.9	0.871	48.0±9.7
PI/(°)	48.1±8.3	47.6±8.4	0.717	47.8±8.3
SS/(°)	36.9±6.7	37.9±7.3	0.415	37.4±7.0
PT/(°)	10.9±5.6	9.7±6.6	0.254	10.3±6.2
C₇-S₁ SVA/mm	-29.1±30.9	-14.9±29.7	0.009^#	-21.6±31.0

Parameter	Type 1 (n=20)	Type 2 (n=42)	Type 3 (n=42)	Type 4 (n=22)	P
SS/(°)	< 35°	< 35°	35°-45°	>35°	0.000^#
Cervical alignment
C₀-C₂/(°)	14.5±7.2	14.1±7.1	16.5±6.2	15.5±6.7	0.426
C₂-C₃/(°)	1.3±3.3	2.1±3.8	1.5±3.4	1.6±3.4	0.806
C₃/(°)	2.4±3.4	0.6±3.3	0.4±3.5	-0.6±3.6	0.051
C₃-C₄/(°)	1.8±4.3	0.7±3.8	0.7±3.7	2.1±3.2	0.375
C₄/(°)	1.3±3.3	0.0±3.7	-0.2±3.4	-0.8±3.6	0.250
C₄-C₅/(°)	1.9±2.9	0.0±4.1	0.5±3.1	2.3±3.1	0.036^*
C₅/(°)	-0.2±3.4	-1.2±3.2	-1.4±3.4	-1.3±3.9	0.626
C₅-C₆/(°)	1.8±2.3	0.6±4.0	1.2±3.4	2.9±3.8	0.088
C₆/(°)	0.9±2.6	-1.1±3.3	-0.5±4.0	0.0±2.2	0.142
C₆-C₇/(°)	4.5±3.0	3.9±4.3	3.5±3.0	5.3±3.8	0.246
C₇/(°)	3.3±2.7	2.3±2.6	2.0±3.1	2.3±2.2	0.388
C₂-C₇/(°)	18.9±14.1	7.8±14.2	7.7±11.1	13.9±13.5	0.005^#
C₀-C₇/(°)	33.4±11.5	21.9±14.5	24.7±10.0	29.4±12.2	0.004^#
T₁ slope/(°)	27.8±7.2	24.3±7.3	26.7±6.4	27.1±7.0	0.204
C₂-C₇ SVA/mm	17.5±9.6	19.3±7.3	19.4±7.9	16.7±7.4	0.499
CGH-C₇ SVA/mm	19.1±15.9	23.3±10.5	24.3±12.5	22.8±11.4	0.485
Whole spine alignment
TK/(°)	25.9±7.6	20.9±7.1	26.0±6.3	27.8±5.5	0.000^#
LL/(°)	47.3±10.0	43.9±9.1	49.7±9.0	53.3±8.9	0.001^#
PI/(°)	43.3±5.9	43.6±7.0	50.7±7.4	54.7±7.6	0.000^#
SS/(°)	33.0±7.1	34.1±4.3	38.4±5.3	46.0±6.3	0.000^#
PT/(°)	10.4±6.0	9.5±5.5	12.0±6.7	8.5±6.1	0.126
C₇-S₁SVA/mm	-28.2±27.5	-19.4±31.9	-24.5±33.2	-14.1±27.7	0.436

Items	C₂-C₇	C₀-C₇	C₂-C₇SVA	CGH-C₇SVA
T₁ slope	0.419^#	0.463^#	0.274^#	0.209^*
TK	0.240^#	0.319^#	0.166	-0.048
LL	0.015	0.115	0.052	0.026
PI	-0.071	-0.020	-0.009	0.045
SS	-0.011	0.029	0.019	0.019
C₇-S₁SVA	0.159	0.058	-0.025	-0.022

	C₀-C₂	C₂-C₃	C₃-C₄	C₄-C₅	C₅-C₆	C₆-C₇	C₂-C₇	C₀-C₇	T₁ slope
C₀-C₂	1	-0.364^#	-0.206^*	-0.222^*	-0.132	-0.113	-0.349^#	0.158	0.079
C₂-C₃		1	0.408^#	0.273^#	0.128	0.031	0.417^#	0.248^#	0.058
C₃-C₄			1	0.544^#	0.469^#	0.186^*	0.525^#	0.449^#	0.175
C₄-C₅				1	0.610^#	0.215^*	0.632^#	0.564^#	0.322^#
C₅-C₆					1	0.349^*	0.488^#	0.439^#	0.353^#
C₆-C₇						1	0.280^#	0.226^*	0.074
C₂-C₇							1	0.870^#	0.419^#
C₀-C₇								1	0.463^#
T₁ slope									1

Normative values of cervical sagittal alignment according to the whole spine balance: Based on 126 asymptomatic Chinese young adults

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Items	Lordotic	Straight	Sigmoid	Kyphotic	Total
Type 1	9	9	0	2	20
Type 2	14	22	0	6	42
Type 3	7	28	2	5	42
Type 4	9	11	1	1	22
Total	39	70	3	14	126

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