The Effect of Cervical Lordosis on Cervical Disc Degeneration in Patients with a High T1 Slope

Sung-Ha Hong; Seung-Hwan Lee; Byeong-Mun Park; Kyung-Sub Song; Sung-Tae Lim

doi:10.4184/jkss.2018.25.2.54

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Hong, Lee, Park, Song, and Lim: The Effect of Cervical Lordosis on Cervical Disc Degeneration in Patients with a High T1 Slope

Original Article

Journal of Korean Spine Surg 2018;25(2):54-59.

Published online: 30 June 2018

DOI: https://doi.org/10.4184/jkss.2018.25.2.54

The Effect of Cervical Lordosis on Cervical Disc Degeneration in Patients with a High T1 Slope

Sung-Ha Hong, M.D.^∗, Seung-Hwan Lee, M.D., Byeong-Mun Park, M.D., Kyung-Sub Song, M.D., Sung-Tae Lim, M.D.^∗

Department of Orthopaedic Surgery, Gwangmyeong Sungae Hospital, Gwangmyeong, Korea

^∗Department of Orthopaedic Surgery, Sung-Ae Hospital, Seoul, Korea

Corresponding author: Seung-Hwan Lee, M.D. ORCID ID: Sung-Ha Hong: https://orcid.org/0000-0002-2913-0381 Seung-Hwan Lee: https://orcid.org/0000-0002-0432-3857 Byeong-Mun Park: https://orcid.org/0000-0003-2637-4257 Kyung-Sub Song: https://orcid.org/0000-0001-8345-5550 Sung-tae Lim: https://orcid.org/0000-0002-0858-8158 Department of Orthopaedic Surgery, Gwangmyeong Sungae Hospital, 36 Digital-ro, Gwangmyeong City, Gyeongido, 14241, Korea TEL: +82-2-2680-7699, FAX: +82-2-2680-7755 E-mail: java5885@gmail.com

Received 13 March 20185 April 2018 Accepted 11 June 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

Retrospective evaluation.

Objectives

To analyze the effect of cervical lordosis on cervical disc degeneration in patients with a high T1 slope.

Summary of Literature Review

The T1 slope is known to be a parameter that may be very useful in evaluating sagittal balance. We previously reported that a low T1 slope was a potential risk factor for cervical spondylosis, especially in the C6-7 cervical segment. However, no study has analyzed the effect of cervical lordosis in patients with a high T1 slope (>25) on cervical disc degeneration.

Materials and Methods

Seventy-seven patients with a high T1 slope who underwent cervical spine MRI in our orthopedic clinic were enrolled. Patients were divided into 2 groups according to cervical compensation. The radiologic parameters obtained from radiography and cervical spine MRI were compared between the uncompensated group (cervical lordosis <25) and the compensated group (cervical lordosis ≥25).

Results

In the uncompensated group, the average degeneration grade of each segment was 2.72 (±0.70) in C2-3, 3.00 (±0.76) in C3-4, 3.02 (±0.91) in C4-5, 3.37 (±0.95) in C5-6, and 2.95 (±0.98) in C6-7. The average degeneration grade of each segment in the compensated group was 2.38 (±0.78) in C2-3, 2.38 (±0.60) in C3-4, 2.62 (±0.60) in C4-5, 2.82 (±0.72) in C5-6, and 2.41 (±0.74) in C6-7. The degeneration grade was significantly higher in the uncompensated group than in the compensated group for all cervical segments. The risk of high-grade degeneration of C3-4 was significantly higher in the uncompensated group (odds ratio = 6.268; 95% CI, 2.232-17.601; p<.001).

Conclusions

Patients with a high T1 slope without compensation of cervical lordosis had a higher grade of degeneration in all cervical segments.

Keywords: Cervical disc degeneration, T1 slope, Cervical lordosis

REFERENCES

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Fig 1.

Radiographic example of a 55-year-old female patient without cervical compensation. (A) Upright lateral X-ray. (B) T2-weighted sagittal image on cervical magnetic resonance imaging.

Fig 2.

Radiographic example of a 51-year-old female patient with cervical compensation. (A) Upright lateral X-ray. (B) T2-weighted sagittal image on cervical magnetic resonance imaging.

Table 1.

Comparison between compensated group and uncompensated group

	Compensated group(34)	Uncompensated group(43)	p-value
Age (yr)	60.18(±5.22)	61.72(±6.61)	0.269
Weight (kg)	61.68(±7.44)	64.58(±6.77)	0.077
Height (cm)	162.35(±8.35)	163.37(±8.51)	0.6
BMI (kg/m²)	23.36(±1.70)	24.20(±1.82)	0.042
T1 slope	31.59(±4.43)	27.14(±2.71)	<0.001
Cervical lordosis	32.26(±6.39)	7.16(±2.52)	<0.001
Male:Female	17:17	29:14	0.121

Values are presented as mean±standard deviation.

Table 2.

Comparison of radiologic parameter on MRI between compen sated group and uncompensated group using t-test

	Compensated group(34)	Uncompensated group(43)	p-value
C2-3	2.38(±0.78)	2.72(±0.70)	0.049
C3-4	2.38(±0.60)	3.00(±0.76)	<0.001
C4-5	2.62(±0.60)	3.02(±0.91)	0.029
C5-6	2.82(±0.72)	3.37(±0.95)	0.007
C6-7	2.41(±0.74)	2.95(±0.98)	0.009

Table 3.

Comparison of radiologic parameter between compensated group and uncompensated group using chi-square test

	Compensated group(34)	Uncompensated group(43)	p-value
C2-3 low:high grade	19(55.9%):14(44.1%)	16(37.2%):27(62.8%)	0.102
C3-4 low:high grade	21(61.8%):13(38.2%)	9(20.9%):34(79.1%)	<0.001
C4-5 low:high grade	13(38.2%):21(61.8%)	13(30.2%):30(69.8%)	0.461
C5-6 low:high grade	12(35.3%):22(64.7%)	7(16.3%):36(83.7%)	0.055
C6-7 low:high grade	21(61.8%):13(38.2%)	16(37.2%):27(62.8%)	0.032

Table 4.

Odds ratio of high grade cervical degeneration of C3-4 on MRI by logistic regression analysis

	Odd ratio	p-value	95% CI
Cervical decompensation	6.268	<0.001	2.232-17.601
Male gender	0.935	0.916	0.269-3.246
Age	0.992	0.876	0.895-1.100

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