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A New Piece of the Puzzle to Understand Cervical Sagittal Alignment: Utilizing a Novel Angle δ to Describe the Relationship among T1 Vertebral Body Slope, Cervical Lordosis, and Cervical Sagittal Alignment.

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Date
2020-03
Authors
Goldschmidt, Ezequiel
Angriman, Federico
Agarwal, Nitin
Trevisan, Marcos
Zhou, James
Chen, Katherine
Gerszten, Peter C
Kanter, Adam S
Okonkwo, David O
Passias, Peter
Scheer, Justin
Protopsaltis, Themistocles
Lafage, Virginie
Lafage, Renaud
Schwab, Frank
Bess, Shay
Ames, Christopher
Smith, Justin S
Shaffrey, Christopher I
Miller, Emily
Jain, Amit
Neuman, Brian
Sciubba, Daniel M
Burton, Douglas
Hamilton, D Kojo
International Spine Study Group (ISSG)
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Abstract
Cervical alignment has become increasingly important in the planning of spine surgery. A relationship between the slope of T1 (T1S), the cervical lordosis (CL), and the overall cervical sagittal vertical axis (cSVA) has previously been demonstrated, but the exact nature of this relationship is poorly understood. In this study, we derive theoretical and empirical equations to better understand how T1S and CL affect cSVA. The first equation was developed on a theoretical basis using inherent trigonometric relationships of the cervical spine. By treating the cervical spine as the arc of a circumference, and by taking into account the cervical height (CH), the geometric relationship between theT1S, CL, and cSVA was described via a trigonometric identity utilizing a novel angle δ subtended by the CH and cSVA (δ = T1S-CL/2). The second equation was developed on an empiric basis by performing a multiple linear regression on data obtained from a retrospective review of a large multicenter deformity database. The theoretical equation determined that the value of cSVA could be expressed as: $cSVA\ = \ CH*{\rm{tan}}( {\pi /180*( {T1S - CL/2} )} )$. The empirical equation determined that value of cSVA could be expressed as: $cSVA=({1.1*T1} )\ - ( {0.43*CL} ) + 6.69$. In both, the sagittal alignment of the head over the shoulders is directly proportional to the T1S and inversely proportional to CL/2. These 2 equations may allow surgeons to better understand how the CL compensates for the T1S, to accurately predict the postoperative cSVA, and to customize cervical interbody grafts by taking into consideration each individual patient's specific cervical spine parameters.
Type
Journal article
Subject
International Spine Study Group (ISSG)
Permalink
https://hdl.handle.net/10161/20367
Published Version (Please cite this version)
10.1093/neuros/nyz088
Publication Info
Goldschmidt, Ezequiel; Angriman, Federico; Agarwal, Nitin; Trevisan, Marcos; Zhou, James; Chen, Katherine; ... International Spine Study Group (ISSG) (2020). A New Piece of the Puzzle to Understand Cervical Sagittal Alignment: Utilizing a Novel Angle δ to Describe the Relationship among T1 Vertebral Body Slope, Cervical Lordosis, and Cervical Sagittal Alignment. Neurosurgery, 86(3). pp. 446-451. 10.1093/neuros/nyz088. Retrieved from https://hdl.handle.net/10161/20367.
This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.
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Scholars@Duke

Shaffrey

Christopher Ignatius Shaffrey

Professor of Orthopaedic Surgery
I have more than 25 years of experience treating patients of all ages with spinal disorders. I have had an interest in the management of spinal disorders since starting my medical education. I performed residencies in both orthopaedic surgery and neurosurgery to gain a comprehensive understanding of the entire range of spinal disorders. My goal has been to find innovative ways to manage the range of spinal conditions, straightforward to complex. I have a focus on managing patients with complex s
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