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Each vertebra can be separated into three functional parts: the vertebral body/intervertebral discs, the spinal canal, and the transverse/spinous processes/facet joints ( 2). Classically, the spine is separated into 5 regions consisting of: 7 cervical vertebrae, 12 thoracic vertebrae, 5 lumbar vertebrae, 5 fused sacral vertebrae, and the 4 fused bones of the coccyx. While primarily functioning to protect the spinal cord from significant impact and injury, it also functions to support the weight-bearing forces of the body and aid in mobility/flexibility. The spine, or vertebral column, is a network of 33 bones, separated/cushioned by intervertebral discs, and stabilized by surrounding ligaments/musculature. The aim of our review is to investigate the anatomic/physiologic variations of global spine alignment and its impact on cervical spine pathology, as well as patient-reported outcomes (PRO).Ĭervical/global spine anatomy and biomechanics Moreover, the recent literature has examined the relationship of cervical alignment to the alignment of the thoracolumbar spine and the importance of considering the entire spinal axis in surgical decision making. While studies have predominantly focused on the lumbosacral-pelvic axis, recent interest in the field of cervical spine pathology/deformity has emphasized the importance of cervical sagittal alignment and its impact on symptomatology and surgical planning. The Debousset theory ( 1) of the “conus of economy” stressed the importance of spinopelvic balance in providing a framework to maintain an upright posture and exert minimal effort/energy expenditure. Similarly, improvements in bone graft substitutes such as bone morphogenetic protein and grafting materials have helped to improve fusion success rates once spinal alignment is optimized. Novel innovations in surgical techniques, including segmental instrumentation, interbody cages, and a variety of osteotomy techniques have all been designed to help contribute to overall spinal stability and improved spine alignment. With the emergence of modern technology and advanced surgical techniques, the importance of understanding global spine alignment has evolved as a critical pillar in determining severity of spinal pathology and operative decision-making. Keywords: Quality of life (QOL) cervical complications spine alignment global alignment Policy of Dealing with Allegations of Research Misconduct.Policy of Screening for Plagiarism Process.Furthermore, some clinical signs can be present for different conditions, so a diagnosis should not be made based solely on a few clinical signs. This is not a complete list of clinical signs for long-tract deficits associated with cervical myelopathy. See Spinal Cord Compression and Dysfunction from Cervical Stenosis Difficulty walking and placing one foot in front of the other (tandem walking).Flicking middle finger causes thumb and index finger to flex (Hoffman reflex).Scratching foot’s sole causes big toe to go up (Babinski reflex) instead of down (normal reflex).Forced ankle extension causes foot to involuntarily move up and down (clonus).Accentuated deep tendon reflexes in the knee and ankle (hyperreflexia).Symptomatic cervical myelopathy leads to several functions of the nerves in the spinal cord not working properly, called “deficits.” These nerve deficits can be picked up from clinical signs during the physical exam.įor example, one or more of the following signs could be present: Clinical Signs of Cervical Stenosis with Myelopathy