Kyphosis types of the spine cervical-thoracic junction

Abstract

Introduction. The strengthening of thoracic kyphosis and forward head posture is one of the urgent problems of modern man. Such changes are most often detected for elderly and senile people. However, today these features are also detected for young people. Digital radiography can objectively assess the position of the cervical and thoracic vertebrae. However, the criteria for reliably registering the position of the vertebrae of the cervicalthoracic junction have not yet been developed.The aim of the study — to develop a method for assessing the position of the vertebrae of the cervical-thoracic junction according to digital radiographs; to develop a typology of the vertebra positions of the cervical-thoracic junction; to study the frequency of vertebral position types for the cervical-thoracic junction for different age groups.Materials and methods. Spine X-ray images in the sagittal plane for 141 adult patients with dorsopathies were studied. The selection of patients was random and there were four age groups: 32 persons aged 21 to 45, 32 persons aged 46 to 59, 50 persons aged 60 to 74 and 21 persons aged 75 to 88 year-old. The study was conducted on PC screen, without the patient′s presence. A single digital X-ray image of the spine for each patient in the sagittal plane was obtained. On the combined digital radiograph, the occipital vertical was drawn along all parts of the spine, starting from the external hillock of the occipital bone downwards, and the anteroposterior CV–TV axes of the vertebrae (r axes) were applied. At the points of intersection of the axes with the occipital vertical, the perpendiculars to the axis were restored, and the angles between the perpendiculars and the vertical — the angles of the anteroposterior axes of the vertebrae (r angles) — were measured. Statistical analysis was performed using the MS Offi ce Excel 2007 and Statistica 12 software packages.Results. It was found that the values of the anteroposterior axe angles r of CVII–TIII vertebrae can serve as criteria for determining the spatial position of the cervical-thoracic junction vertebrae. There are 4 types of the shape of the cervical-thoracic junction. Type I is a straightened kyphosis («giraffe neck»); type II is physiological («harmonious»); type III — enhanced kyphosis («bear withers»); type IV–hyperkyphosis («buffalo hump»). Types III and IV are accompanied by a forward displacement of the head. Straightened cervical-thoracic junction kyphosis — type I — was diagnosed in 21 (15 %) people, 52 (37 %) patients were assigned to type II, another 48 (34 %) patients had type III, and 20 (14 %) patients had type IV cervical-thoracic junction kyphosis. In young patients aged 21 to 45, as well as in middle-aged patients aged 46 to 59, the most common type was the harmonious type II of cervical-thoracic junction, in elderly patients aged 60 to 74 — type III and close to it in frequency was type III. In elderly patients aged 75 to 88, the IV type of the position of the vertebrae of the cervical-thoracic junction prevailed in frequency.Conclusion. The proposed diagnostic method allows to register the type of the vertebra positions in cervicalthoracic junction for each patient. Four position types of the cervical-thoracic junction vertebrae were determined: straightened kyphosis «giraffe neck», physiological kyphosis «harmonious», enhanced kyphosis «bear withers» and hyperkyphosis «buffalo hump». Increased kyphosis and hyperkyphosis are accompanied by a forward head posture.