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  • Title: The Relationship Between Cervical Degeneration and Global Spinal Alignment in Patients With Adult Spinal Deformity.
    Author: Fujimori T, Le H, Schairer W, Inoue S, Iwasaki M, Oda T, Hu SS.
    Journal: Clin Spine Surg; 2017 May; 30(4):E423-E429. PubMed ID: 28437348.
    Abstract:
    OBJECTIVES: To examine the relationship between cervical degeneration and spinal alignment by comparing patients with adult spinal deformity versus the control cohort. SUMMARY OF BACKGROUND DATA: The effect of degeneration on cervical alignment has been controversial. METHODS: Cervical and full-length spine radiographs of 57 patients with adult spinal deformity and 78 patients in the control group were reviewed. Adult spinal deformity was classified into 3 types based on the primary characteristics of the deformity: "Degenerative flatback" group, "Positive sagittal imbalance" group, and "Hyperthoracic kyphosis" group. Cervical degeneration was assessed using the cervical degeneration index scoring system. RESULTS: The "Degenerative flatback" group had significantly higher total cervical degeneration index score (25±7) than the control group (16±8), the "Positive sagittal imbalance" group (18±8), and the "Hyperthoracic kyphosis" group (12±7) (P<0.01). The "Degenerative flatback" group had significantly less cervical lordosis than the other groups. This reduced amount of cervical lordosis was thought to be induced by a compensatory decrease in thoracic kyphosis. In this group, increased cervical degeneration was significantly associated with a decrease in cervical lordosis. Significantly greater compensatory increase in cervical lordosis was noted in the "Positive sagittal imbalance" group (20±15 degrees) and the "Hyperthoracic kyphosis" group (26±9 degrees) compared with the control group (11±12 degrees) (P<0.02). CONCLUSIONS: Flat cervical spine coexisted with cervical degeneration when compensatory hypothoracic kyphosis was induced by degenerative flatback. In other situations, cervical lordosis could increase as a compensatory reaction against sagittal imbalance or hyperthoracic kyphosis.
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