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  • Title: Influence of T1 Slope on the Cervical Sagittal Balance in Degenerative Cervical Spine: An Analysis Using Kinematic MRI.
    Author: Weng C, Wang J, Tuchman A, Wang J, Fu C, Hsieh PC, Buser Z, Wang JC.
    Journal: Spine (Phila Pa 1976); 2016 Feb; 41(3):185-90. PubMed ID: 26650871.
    Abstract:
    STUDY DESIGN: A retrospective kinematic magnetic resonance imaging (kMRI) study. OBJECTIVE: To evaluate the utility of kMRI in determining the relationship between cervical sagittal balance and TI alignment. SUMMARY OF BACKGROUND DATA: Thoracic inlet parameters play an important role in cervical spine sagittal balance. However, most of the literature is based on lower resolution cervical X-rays or CT scans in the supine position. METHODS: Cervical spine kMRI of 83 patients with degenerative cervical spine conditions (20-68 yr of age) was analyzed for: (1) cervical spine parameters: C2-C7 angle, C2-C7 sagittal vertical axis (SVA), cranial tilt, and cervical tilt; and (2) T1 parameters: thoracic inlet angle (TIA), T1 slope, and neck tilt (NT). Multiple logistic regression analysis and Pearson correlation coefficients were performed. RESULTS: The mean TIA, T1 slope, and NT were 78.0, 33.2, and 44.8°, respectively. The mean C2-7 angle, SVA of C2-C7, cervical tilt, and cranial tilt were -15.4°, 22.0 mm, 18.1°, and 15.1°, respectively. The ratio of cervical:cranial tilt was maintained as 55:45%. A significant correlation was found between the C2-C7 angle and T1 slope (r = 0.731), TIA and C2-C7 angle (r = 0.406), cervical tilt with C2-C7 angle (r = 0.671), T1 slope with TIA (r = 0.429), TIA with neck tilt (r = 0.733), TIA with cervical tilt (r = 0.377), SVA C2-C7 with cervical tilt (r = -0.480), SVA C2-C7 with cranial tilt (r = 0.912), and C2-7 SVA with the ratio of cranial tilt to cervical tilt (r = 0.694). CONCLUSION: An individual with a large T1 slope required large cervical lordosis to preserve physiologic sagittal balance of the cervical spine. Cranial tilt was the cervical parameter most strongly correlated with SVA C2-C7, and thus may be a good parameter to assess decompensation of cervical sagittal balance. LEVEL OF EVIDENCE: 3.
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