Oral Posters: Cervical
Presented by: D. Stein - View Audio/Video Presentation (Members Only)
J. Iorio(1), J. Henry(2), R. Lafage(1), B. Liabaud(1), D. Stein(1), J. Varghese(1,3), B. Sides(4), M. Gupta(4), V. Lafage(1), F. Schwab(1), L. Lenke(5), H.J. Kim(1)
(1) Hospital for Special Surgery, Spine Service, New York, NY, United States
(2) NYU Langone Medical Center, New York, NY, United States
(3) SUNY Downstate Medical Center, Department of Orthopaedic Surgery, Brooklyn, NY, United States
(4) Washington University School of Medicine, Department of Orthopaedic Surgery, St. Louis, MO, United States
(5) Columbia University Medical Center, Department of Orthopaedic Surgery,, New York, NY, United States
Introduction: The literature has demonstrated that pelvic and thoracolumbar sagittal alignment parameters vary with age. Existing studies on age-based variations in cervical alignment have been primarily limited to studies in Asian populations. The purpose of this study was to assess upper and lower cervical sagittal parameters across age groups in a North American Population.
Methods: Prospective single center database. Asymptomatic subjects > 18 yrs who underwent full-body x-rays and completed HRQOL (ODI, NDI) were included. Subjects were divided into 5 age groups (< 35y, 35-44y, 45-54y, 55-64y, ≥65y). Demographics and radiographic parameters were compared between age groups using ANOVA. Cervical parameters included C0-2, C2-7, and C0-7 lordosis; contribution of upper cervical angle to total cervical angle (UpperC%: C0-2 divided by C0-7); C2-7 sagittal vertical axis (cSVA); cervical lordosis apex (CL); T1 slope (T1S); chin-brow vertical angle (CBVA); Slope of Line of Sight (SLS); and McGregor's slope (McGS).
Results: 118 subjects were included. Age groups had similar values for T1S-CL (mean 21.1, range 2-47), cSVA (mean 27mm, range -22-63mm), C0-C2 angle (mean 20.7, range -5-44), and apex of CL (mean C5) (p>0.05). C2-C7 increased significantly with age, < 35y: -2.2; 35-44y: 1.6; 45-54y: 3.6; 55-64y: 10.7; >65y: 11.8 (P< 0.001). C0-C7 increased with age (P< 0.01). There was a trend for UpperC% to decrease with age: < 35y: 94%; 35-44y: 98%; 45-54y: 97%; 55-64y: 70%; >65y: 73% (p>0.05). CBVA, SLS, McGS, and T1S did not change with increased age. Table: Cervical sagittal radiographic parameters; C0-C2 = upper cervical angle; C2-C7 = lower cervical angle; C0-C7= total cervical angle; T1S= T1 Slope; T1S-CL = T1 slope minus Cervical Curvature; cSVA= cervical vertical axis (C2-7)
Conclusion: This study is one of few to describe age-based variations in cervical alignment in a North American population.C2-7 and C0-7 angles increased with age, despite similarities in cSVA. There was a trend for the relative contribution of C0-2 to the total cervical curvature to decrease with age. However, HRQOL were consistent across ages, suggesting these alignment variations represent physiologic aging.