Science In Brief

Chiropractic Litterature Review


The Study: The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery

The Facts:

  1. There have been repeated studies showing a correlation between positive (forward) neck malalignment and future pain and disability following surgery in patients requiring thoracolumbar fusion.
  2. This study looked at "the relationship between regional cervical alignment and postoperative outcomes" in a group of subjects who had undone cervical fusion at multiple levels.
  3. The authors note that there are "large variations in radiographic parameters even in asymptomatic patients."
  4. However the results of this study describe a "pivotal relationship" between sagittal alignment and health related quality of life scores following posterior cervical fusion surgery.
  5. As malalignment of the cervical region increases in the positive (forward) direction there is a correlation with increased neck disability.
  6. In their conclusion, the authors state "the severity of disability increases with positive sagittal malalignment following surgical reconstruction."

Take Home:

As there was an increasing forward (positive) forward shift of the malalignment of the cervical region of these subjects who had undergone cervical fusion at multiple levels there was a corresponding increase in disability.

Reviewer's Comments:

You will note that the authors indicated that although there was a large range in the alignment of asymptomatic patients but that when malalignment did occur, as it moved farther and farther forward, the severity of disability increased. You need to read this article to see just how they measured the spine and determined alignment and all the nuances of this article. But for our purposes, once again we see a relationship between alignment and problems. Among the authors of this article there are no DCs but there are two BAs and six MDs, two of which are also PhDs.    

Reviewer:Roger Coleman DC

Editor’s Comments: Poor posture hurts. Studies like this one are laying the groundwork for both pre and post surgical rehabilitation of the sagittal curves. The surgeons know the value of good posture. What a shame that more chiropractors think we only need to manipulate for pain.  

Editor:Mark R. Payne DC

Reference: Tang JA, Scheer JK, Smith JS, Deviren V, Bess S, Hart RA, Lafage V, Shaffrey CI, Schwab F, Ames CP. The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery. Neurosurgery 2015 Mar;76 Suppl 1:S14-21; discussion S21. doi: 10.1227/01.neu.0000462074.66077.2b

Link to Abstract:

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