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Clin Spine Surg. 2017 May;30(4):E423-E429. doi: 10.1097/BSD.0000000000000327.

The Relationship Between Cervical Degeneration and Global Spinal Alignment in Patients With Adult Spinal Deformity.

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*Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA †Department of Orthopedic Surgery, Sumitomo Hospital, Osaka, Japan ‡Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY §Department of Orthopedic Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo ∥Department of Orthopedic Surgery, Osaka Rosai Hospital, Osaka, Japan ¶Department of Orthopaedic Surgery, Stanford School of Medicine, Stanford, CA.



To examine the relationship between cervical degeneration and spinal alignment by comparing patients with adult spinal deformity versus the control cohort.


The effect of degeneration on cervical alignment has been controversial.


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.


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).


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.

[Indexed for MEDLINE]

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