SIB #366 Cervical Alignment, Sagittal Deformity and Clinical Implications

The Study: Cervical spine alignment, sagittal deformity, and clinical implications: a review.

The Facts:

a. Considering cervical alignment in relationship to the alignment of the rest of the spine and pelvis is important.

b. Spinal misalignment following surgery may promote adjacent-segment disease.

c. “Evidence from a few recent studies suggests correlations between radiographic parameters in the cervical spine and HRQOL.” [Health Related Quality of Life]

d. Surgeons should take sagittal alignment into consideration because cervical kyphosis may cause tension on the spinal cord.

e. Understanding the alignment of the entire spine is important.

f. “…multiple publications have identified the important radiographic parameters

in the thoracolumbar spine that have direct effects on HRQOL.”

g. It should be understood that the cervical spine is very complex.

h. The authors reference other articles to state, “In asymptomatic

normal volunteers a large percentage (approximately 75%–80%) of cervical standing lordosis is localized to C1–2 and relatively little lordosis exists in the lower

cervical levels. Similarly, most lumbar lordosis occurs at the caudal end with L5–S1 having the largest segmental lordotic angle.”

i. Cervical kyphosis is the most common cervical malalignment.

j. “Finally, the future directions of cervical deformity lie in assessing the spine as a whole, including the cervical pelvic relationships.”

Take Home:

The alignment of the cervical spine may be important to quality of life and is affected by the alignment of the rest of the spine and the pelvis.

Reviewer's Comments:

First, no one article should be taken as the having all the answers. Here are some points that you might consider. 1. Spinal alignment should be an important consideration for the clinician. 2. It appears logical that the rest of the spine can influence the cervical lordosis. 3. Just as the lumbar lordosis appears to be an ellipse, the average cervical lordosis might be an ellipse as opposed to a segment of a circle. This article has a lot of parts and you should make up your own mind on what it says. But I very much agree with the authors when they indicate that more research is needed in this area. We don’t have all the answers yet.

Reviewer:  Roger Coleman DC

 Reference: Scheer JK, Tang JA, Smith JS, Acosta FL Jr. Protopsaltis TS, Blondel B, Bess S, Shaffrey CI, Deviren V, Lafage V, Schwab F, Ames CP; International Spine Study Group. Cervical spine alignment, sagittal deformity, and clinical implications: a review. J Neurosurg Spine. 2013 Aug;19(2):141-59. doi: 10.3171/2013.4.SPINE12838. Epub 2013 Jun 14.

 Editor’s Comments: The reader should take note of the larger context in which articles like this one ( as well as many others we have already reviewed in Science In Brief) are being written. These articles are being written by surgeons who are rapidly moving to establish the correction of serious spinal misalignments as a part of their own field of practice. And while I certainly understand that many of these very severe cases may well require surgical interventions, I am doubtful that it will stop there. This movement will in all likelihood expand itself into the treatment of ever less severe cases of spinal alignment and will eventually encroach into the treatment of many patients who could no doubt benefit from corrective chiropractic care. What a shame that our profession is so rapidly trying to move away from sound radiographic analysis and corrective care procedures and instead is focused on pain relief.

Editor: Mark R. Payne DC  

Link to Abstract:

Mark R. Payne DC