Science In Brief

Chiropractic Litterature Review

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Relationship of Sagittal Cervical, Thoracic and Lumbopelvic Alignment

The Study: Relationship among cervical, thoracic, and lumbopelvic sagittal alignment in healthy adults

The Facts:

  1. This study “aimed to evaluate the association between cervical sagittal alignment and total spinal sagittal alignment in terms of cervical lordosis, thoracic kyphosis, lumbar lordosis, and pelvic alignment” in healthy adults.
  2. They used 52 adult subjects composed of both males and females.
  3. The authors noted that changes in the cervical lordosis are affected by age and the condition of the discs and have also been associated with cervical pain.
  4. Subjects with current cervical or lumbar pain or stiff shoulders were excluded from the study.
  5. Both A-P and Lateral (full spine) radiographs were taken of the subjects.
  6. "When the curvature of some of the thoracic or cervical vertebrae is changed, the spinal sagittal alignment compensates for the change without greatly affecting cervical sagittal vertical axis or sagittal vertical axis."

Take Home:

Changes in the status of the spinal curves do not necessarily correlate with changes in the sagittal vertical axis.

Cervical lordosis is directly associated with both increased thoracic kyphosis and C7 tilt angle and vice versa…i.e. an increase (or decrease) in the thoracic kyphosis will likely correlate with a similar increase (or decrease) in the cervical lordosis.

While "cervical sagittal alignment is associated with thoracic sagittal alignment”, it does not appear to be associated with lumbopelvic alignment.

Reviewer's Comments:

I found this very interesting and what it made me think was that imaging appears to be the best way to see many of these types of changes. I am looking hopefully toward certain types of ultrasound and the improvements in that area that may follow to allow us to better understand what is going on in the spine as care progresses.

Reviewer: Roger Coleman DC

Editor’s Comments: I thought it was interesting that while the authors did not note any relationship between lumbopelvic alignment and cervical lordosis, they did cite previous studies which have related both cervical lordosis and lumbopelvic alignment to neck pain/stiffness. Perhaps the reason this study failed to find any relationship between lumbopelvic alignment and cervical lordosis was simply because they only used pain free subjects. In other words, that lack of correlation in cervical/lumbopelvic alignment may just be an artifact of the study’s design. That’s just my two cents worth but it might be worth a look in a future. Hey…I’ve got a great idea! Maybe we can get some physical therapists or orthopedic surgeons to do that study for us since our own colleges and journals have lost all interest in researching spinal alignment and posture particularly if the study involves radiography. (Unfortunately radiography remains the only way to accurately assess these types of postural/structural imbalances…a fact remains an inconvenient truth only for chiropractors. Our competitors aren’t bothered in the least by this fact.)

Editor: Mark R. Payne DC

Reference: Endo K, Suzuki H, Sawaji Y, Nishimura h, Yorifuji M, Murata K, Tanaka H, Sishido T, Yamamoto K. Relationship among cervical, thoracic, and lumbopelvic sagittal alignment in healthy adults. J Orthop Surg (Hong Kong)2016;24:92-6.

Link to Abstract: https://www.ncbi.nlm.nih.gov/pubmed/27122521

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