Science In Brief

Chiropractic Litterature Review

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The Study: Relationship Between T1 Slope and Cervical Alignment Following Multilevel Posterior Cervical Fusion Surgery: Impact of T1 Slope Minus Cervical Lordosis

The Facts:

  1. Previous scientific articles indicate that a plumb line from C7 that is forward by more than 50mm "to the posterior superior aspect of the sacrum, is associated with a deterioration of quality of life in patients with adult spinal deformity."
  2. The authors wished to determine if there was "a relationship between sagittal alignment of the cervical spine" and the patient's quality of life following posterior cervical fusion at multiple levels.
  3. They defined the following measurments:

Cervical lordosis from C2 to C7: The angle formed by measuring the angle between a line erected parallel to the bottom endplate of C2 and the superior endplate of C7.

C2-C7 SVA: A plumb line is dropped from the middle of the body of C2 and the distance is measured between that line and the posterior superior corner of the endplate of C7. A positive number indicates anterior deviation of the line (forward head posture) in relation to the posterior superior corner of the endplate of C7.

T1 slope: They drew a line along the superior endplate of T1 and measured the angle to horizontal.

  1. Neck disability increased with "progressive cervical sagittal malalignment" in this group of patients who had undergone cervical fusion at multiple levels.
  2. Changes in the cervical lordosis from pre to post surgical intervention correlated with neck disability index changes.

Greater mismatches between the T1 slope and the cervical lordosis from C2 to C7 is associated with greater disability

Take Home:

This is a complex article with a very simple conclusion of importance to the chiropractic profession. The conclusion is that once again spinal misalignment produces symptoms. Some study of the article is needed to thoroughly understand their methods, but it is not complex to understand the principle that spinal misalignment is related to outcomes.

Reviewer's Comments:

As with all these articles, you should read this one to get all the information, but it reinforces once again that spinal alignment matters. And once again, the literature is written by the medical profession, in this case four MD PhDs, and not by chiropractors.

Reviewer:Roger Coleman DC

Editor’s Comments: This article and any number of similar articles we have previously reviewed, clearly documents the need for healthy spinal structure i.e. sagittal curves. As our competition continues to document the benefits of good posture, it is only a matter of time until they (not us) are getting paid to correct spinal posture.

Editor:Mark R. Payne DC

Reference: Hyun SJ, Kim KJ, Jahng TA, Kim HJ. Relationship Between T1 Slope and Cervical Alignment Following Multilevel Posterior Cervical Fusion Surgery: Impact of T1 Slope Minus Cervical Lordosis. Spine 2016;41:E396-402.

Link to Abstract: http://www.ncbi.nlm.nih.gov/pubmed/26583469

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