Objective To explore the relationship between cervical articular process joint degeneration and sagittal sequence changes as well as axial pain through CT and MR imaging. Methods A retrospective analysis was conducted on 156 patients with cervical spondylosis who visited our department from January 2019 to January 2022. Based on cervical CT imaging, patients were divided into an observation group (articular process degeneration group) of 72 patients with an average age of (51±12.3) years and a control group (normal articular process group) of 84 patients with an average age of (48±11.4) years. The incidence and severity of axial pain were recorded. Cervical MR images were used to measure the C2-C7 Cobb angle, sagittal vertical axis (SVA) distance from C2 to C7, T1 slope (T1S), thoracic inlet angle (TIA), neck tilt (NT), and thoracic kyphosis angle (TK). Additionally, the degree of intervertebral disc degeneration was recorded. Results In the observation group, 65 patients experienced axial pain with an average VAS score of (6.4±1.3), while in the control group, 30 patients experienced axial pain with an average VAS score of (3.3±0.9), with statistical difference (P=0.00). The intervertebral disc degeneration scores for the observation and control groups were (4.9±1.1) and (2.5±0.7), respectively, with a statistically significant difference between the two groups (P=0.00). Among the measured cervical sagittal parameters, the T1S angle was (27.5°±5.4°) in the articular process degeneration group and (22.1°±4.8°) in the control group, showing a significant difference of 5.4° (P=0.00). There was also a significant difference in the TK angle between the two groups difference of 4.1° (P=0.00). However, there were no statistically significant differences in TIA (P=0.18), NT (P=0.34), C2-C7 Cobb angle (P=0.08), and SVA (P=0.08) between the two groups. Conclusions Cervical articular process degeneration is positively correlated with the occurrence of axial pain. The increase in T1S and TK may be related to articular process joint degeneration.
Key words
Cervical spondylosis; /
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Facet joint; /
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Sagittal parameters; /
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Axial pain
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References
[1] Usunier K, Hynes M, Schuster JM, et al. Clinical diagnostic tests versus medial branch blocks for adults with persisting cervical zygapophyseal joint pain: a systematic review and meta-analysis[J]. Physiother Can, 2018, 70(2): 179-187. DOI: 10.3138/ptc.2016-89.mt.
[2] 徐聪, 于雪峰, 廖琦, 等. MRI和CT在测评退行性颈椎滑脱关节突关节矢状位不对称角中可靠性的比较[J]. 中国临床解剖学杂志, 2016, 34(1): 63-67. DOI: 10.13418/j.issn.1001-165x.2016.01.017.
Xu C, Yu XF, Liao Q, et al. Comparison of the reliability of computed tomography and magnetic resonance imaging in the evaluation of facet tropism in degenerative cervical spondylolisthesis [J]. Chin J Clin Anat, 2016, 34(1): 63-67. DOI: 10.13418/j.issn.1001-165x.2016.01.017.
[3] Rong X, Liu Z, Wang B, et al. Relationship between facet tropism and facet joint degeneration in the sub-axial cervical spine[J]. BMC Musculoskelet Disord, 2017, 18(1): 86. DOI: 10.1186/s12891-017-1448-x.
[4] Ferracini GN, Chaves TC, Dach F, et al. Analysis of the cranio-cervical curvatures in subjects with migraine with and without neck pain[J]. Physiotherapy, 2017,103(4):392-399. DOI:10.1016/j.physio.2017.03. 004
[5] Moustafa IM, Diab AA, Hegazy F, et al. Does improvement towards a normal cervical sagittal configuration aid in the management of cervical myofascial pain syndrome: a 1- year randomized controlled trial[J]. BMC Musculoskelet Disord, 2018, 19(1): 396. DOI: 10.1186/s12891-018-2317-y.
[6] Zehra U, Cheung JPY, Bow C, et al. Multidimensional vertebral endplate defects are associated with disc degeneration, modic changes, facet joint abnormalities, and pain[J]. J Orthop Res, 2019, 37(5): 1080-1089. DOI: 10.1002/jor.24195.
[7] Gao K, Zhang J, Lai J, et al. Correlation between cervical lordosis and cervical disc herniation in young patients with neck pain[J]. Medicine (Baltimore),2019, 98(31):e16545. DOI:10.1097/MD.00000 00000016545.
[8] 徐聪, 徐庆平, 艾雯, 等. 颈椎关节突关节矢状位角的不对称性和关节突关节退变关系的影像学研究[J]. 中国临床解剖学杂志, 2021, 39(5): 535-538, 545. DOI: 10.13418/j.issn.1001-165x.2021.05.007.
Xu C, Xu QP, Ai W, et al. Imaging study on the relationship between sagittal angle asymmetry of cervical facet joint and cervical facet joint degeneration [J]. Chin J Clin Anat, 2021, 39(5): 535-538, 545. DOI: 10.13418/j.issn.1001-165x.2021.05.007.
[9] Zhou J, Li L, Li T, et al. Preoperative Modic changes are related to axial symptoms after anterior cervical discectomy and fusion[J]. J Pain Res, 2018, 11: 2617-2623. DOI: 10.2147/JPR.S172953.
[10]Rong X, Liu Z, Wang B, et al. The facet orientation of the subaxial cervical spine and the implications for cervical movements and clinical conditions[J]. Spine (Phila Pa 1976), 2017, 42(6): E320-E325. DOI: 10.1097/BRS.0000000000001826.
[11]Li J, Qin S, Li Y, et al. Modic changes of the cervical spine: T1 slope and its impact on axial neck pain[J]. J Pain Res, 2017, 10: 2041-2045. DOI: 10.2147/JPR.S144814.
[12]Lv B, Fan X, Ding H, et al. Analysis of correlation between age and cervical facet joint degeneration and modic changes in patients with cervical spondylotic myelopathy[J]. Med Sci Monit, 2019, 25: 7882-7888. DOI: 10.12659/MSM.915136.
[13]Lv B, Xu T, Wan B, et al. C7 slope and its association with serum lipid levels and Modic changes in patients with cervical spondylotic myelopathy[J]. J Pain Res, 2019, 12: 1767-1776. DOI: 10.2147/JPR.S188823.
[14]Yeh KT, Lee RP, Chen IH, et al. Are there age- and sex-related differences in spinal sagittal alignment and balance among taiwanese asymptomatic adults[J]? Clin Orthop Relat Res, 2018, 476(5): 1010-1017. DOI: 10.1007/s11999.0000000000000140.
[15]Jun HS, Kim JH, Ahn JH, et al. T1 slope and degenerative cervical spondylolisthesis[J]. Spine (Phila Pa 1976), 2015, 40(4): E220-E226. DOI: 10.1097/BRS.0000000000000722.
[16]Yang BS, Lee SK, Song KS, et al. The use of T1 sagittal angle in predicting cervical disc degeneration[J]. Asian Spine J, 2015, 9(5): 757-761. DOI: 10.4184/asj.2015.9.5.757.
[17]Zhao J, Jiang R, Yang Y, et al. Preoperative T1 slope as a predictor of change in cervical alignment and range of motion after cervical disc arthroplasty[J]. Med Sci Monit, 2017, 23: 5844-5850. DOI: 10.12659/msm.906944.
[18]Ma Z, Liu P, Liu J, et al. Kinematic analysis of the relationship between Modic changes and sagittal balance parameters in the cervical spine[J]. Medicine (Baltimore), 2017, 96(33): e7699. DOI: 10.1097/MD.000000 0000007699.
[19]Lee SH, Hyun SJ, Jain A. Cervical sagittal alignment: literature review and future directions[J]. Neurospine, 2020, 17(3): 478-496. DOI: 10.14245/ns.2040392.196.
[20]Liu C, Li Y, Li X, et al. Correction: factors related to T1 slope:spinopelvic balance and thoracic compensation[J]. BMC Surg, 2023, 23(1): 174. DOI: 10.1186/s12893-023-02074-8.
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