Natural head posture in the setting of sagittal spinal deformity: Validation of chin-brow vertical angle, slope of line of sight, and McGregor's slope with health-related quality of life

Renaud Lafage, Vincent Challier, Barthelemy Liabaud, Shaleen Vira, Emmanuelle Ferrero, Bassel G. Diebo, Shian Liu, Jean Marc Vital, Keyvan Mazda, Themistocles S. Protopsaltis, Thomas J. Errico, Frank J. Schwab, Virginie Lafage

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

BACKGROUND: The maintenance of horizontal gaze is an essential function of upright posture and global sagittal spinal alignment. Horizontal gaze is classically measured by the chin-brow vertical angle (CBVA), which is not readily measured on most lateral spine radiographs. OBJECTIVE: To evaluate relations between CBVA and the slope of the line of sight, the slope of McGregor's line (McGS), and Oswestry Disability Index. METHODS: Patients were identified from a single center database of 531 spine patients who underwent full-body EOS x-rays. Correlations between CBVA, the slope of the line of sight, and McGS were assessed. Using a quadratic regression with Oswestry Disability Index and CBVA, windows of low disability were identified. Comparison of sagittal spinopelvic parameters was carried out between patients with "ascending gaze" and "neutral position." RESULTS: Three hundred three patients were included (74% female, mean age 54.8 years, body mass index 26.6 ± 6.0 kg/m 2). CBVA strongly correlated with the slope of the line of sight (r 0.996) and McGS (r 0.862). Regression studies between Oswestry Disability Index and CBVA yielded a range of values corresponding to low disability (-4.7 degrees to 17.7 degrees). Similarly, a low disability range for the slope of the line of sight (-5.1 degrees to 18.5 degrees) and McGS (-5.7 degrees to 14.3 degrees) was computed. Patients with "ascending gaze" had a worse spinopelvic alignment than "neutral position" patients. CONCLUSION: The slope of the line of sight and McGS correlated strongly with CBVA and can be used as surrogate measures. The range of values for these measures corresponding to low disability was identified. These values can be used as a general guideline to assess alignment for diagnostic purposes. Cervical compensatory mechanism may modify the natural head position in sagittally misaligned patients.

Original languageEnglish (US)
Pages (from-to)108-115
Number of pages8
JournalNeurosurgery
Volume79
Issue number1
DOIs
StatePublished - Jul 1 2016
Externally publishedYes

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Chin
Posture
Head
Quality of Life
Spine
Body Mass Index
Maintenance
X-Rays
Databases
Guidelines

Keywords

  • Chin-brow vertical angle
  • Frankfort plane
  • Horizontal gaze
  • McGregor slope
  • Oswestry Disability Index
  • Sagittal alignment

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Natural head posture in the setting of sagittal spinal deformity : Validation of chin-brow vertical angle, slope of line of sight, and McGregor's slope with health-related quality of life. / Lafage, Renaud; Challier, Vincent; Liabaud, Barthelemy; Vira, Shaleen; Ferrero, Emmanuelle; Diebo, Bassel G.; Liu, Shian; Vital, Jean Marc; Mazda, Keyvan; Protopsaltis, Themistocles S.; Errico, Thomas J.; Schwab, Frank J.; Lafage, Virginie.

In: Neurosurgery, Vol. 79, No. 1, 01.07.2016, p. 108-115.

Research output: Contribution to journalArticle

Lafage, R, Challier, V, Liabaud, B, Vira, S, Ferrero, E, Diebo, BG, Liu, S, Vital, JM, Mazda, K, Protopsaltis, TS, Errico, TJ, Schwab, FJ & Lafage, V 2016, 'Natural head posture in the setting of sagittal spinal deformity: Validation of chin-brow vertical angle, slope of line of sight, and McGregor's slope with health-related quality of life', Neurosurgery, vol. 79, no. 1, pp. 108-115. https://doi.org/10.1227/NEU.0000000000001193
Lafage, Renaud ; Challier, Vincent ; Liabaud, Barthelemy ; Vira, Shaleen ; Ferrero, Emmanuelle ; Diebo, Bassel G. ; Liu, Shian ; Vital, Jean Marc ; Mazda, Keyvan ; Protopsaltis, Themistocles S. ; Errico, Thomas J. ; Schwab, Frank J. ; Lafage, Virginie. / Natural head posture in the setting of sagittal spinal deformity : Validation of chin-brow vertical angle, slope of line of sight, and McGregor's slope with health-related quality of life. In: Neurosurgery. 2016 ; Vol. 79, No. 1. pp. 108-115.
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abstract = "BACKGROUND: The maintenance of horizontal gaze is an essential function of upright posture and global sagittal spinal alignment. Horizontal gaze is classically measured by the chin-brow vertical angle (CBVA), which is not readily measured on most lateral spine radiographs. OBJECTIVE: To evaluate relations between CBVA and the slope of the line of sight, the slope of McGregor's line (McGS), and Oswestry Disability Index. METHODS: Patients were identified from a single center database of 531 spine patients who underwent full-body EOS x-rays. Correlations between CBVA, the slope of the line of sight, and McGS were assessed. Using a quadratic regression with Oswestry Disability Index and CBVA, windows of low disability were identified. Comparison of sagittal spinopelvic parameters was carried out between patients with {"}ascending gaze{"} and {"}neutral position.{"} RESULTS: Three hundred three patients were included (74{\%} female, mean age 54.8 years, body mass index 26.6 ± 6.0 kg/m 2). CBVA strongly correlated with the slope of the line of sight (r 0.996) and McGS (r 0.862). Regression studies between Oswestry Disability Index and CBVA yielded a range of values corresponding to low disability (-4.7 degrees to 17.7 degrees). Similarly, a low disability range for the slope of the line of sight (-5.1 degrees to 18.5 degrees) and McGS (-5.7 degrees to 14.3 degrees) was computed. Patients with {"}ascending gaze{"} had a worse spinopelvic alignment than {"}neutral position{"} patients. CONCLUSION: The slope of the line of sight and McGS correlated strongly with CBVA and can be used as surrogate measures. The range of values for these measures corresponding to low disability was identified. These values can be used as a general guideline to assess alignment for diagnostic purposes. Cervical compensatory mechanism may modify the natural head position in sagittally misaligned patients.",
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AU - Lafage, Renaud

AU - Challier, Vincent

AU - Liabaud, Barthelemy

AU - Vira, Shaleen

AU - Ferrero, Emmanuelle

AU - Diebo, Bassel G.

AU - Liu, Shian

AU - Vital, Jean Marc

AU - Mazda, Keyvan

AU - Protopsaltis, Themistocles S.

AU - Errico, Thomas J.

AU - Schwab, Frank J.

AU - Lafage, Virginie

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N2 - BACKGROUND: The maintenance of horizontal gaze is an essential function of upright posture and global sagittal spinal alignment. Horizontal gaze is classically measured by the chin-brow vertical angle (CBVA), which is not readily measured on most lateral spine radiographs. OBJECTIVE: To evaluate relations between CBVA and the slope of the line of sight, the slope of McGregor's line (McGS), and Oswestry Disability Index. METHODS: Patients were identified from a single center database of 531 spine patients who underwent full-body EOS x-rays. Correlations between CBVA, the slope of the line of sight, and McGS were assessed. Using a quadratic regression with Oswestry Disability Index and CBVA, windows of low disability were identified. Comparison of sagittal spinopelvic parameters was carried out between patients with "ascending gaze" and "neutral position." RESULTS: Three hundred three patients were included (74% female, mean age 54.8 years, body mass index 26.6 ± 6.0 kg/m 2). CBVA strongly correlated with the slope of the line of sight (r 0.996) and McGS (r 0.862). Regression studies between Oswestry Disability Index and CBVA yielded a range of values corresponding to low disability (-4.7 degrees to 17.7 degrees). Similarly, a low disability range for the slope of the line of sight (-5.1 degrees to 18.5 degrees) and McGS (-5.7 degrees to 14.3 degrees) was computed. Patients with "ascending gaze" had a worse spinopelvic alignment than "neutral position" patients. CONCLUSION: The slope of the line of sight and McGS correlated strongly with CBVA and can be used as surrogate measures. The range of values for these measures corresponding to low disability was identified. These values can be used as a general guideline to assess alignment for diagnostic purposes. Cervical compensatory mechanism may modify the natural head position in sagittally misaligned patients.

AB - BACKGROUND: The maintenance of horizontal gaze is an essential function of upright posture and global sagittal spinal alignment. Horizontal gaze is classically measured by the chin-brow vertical angle (CBVA), which is not readily measured on most lateral spine radiographs. OBJECTIVE: To evaluate relations between CBVA and the slope of the line of sight, the slope of McGregor's line (McGS), and Oswestry Disability Index. METHODS: Patients were identified from a single center database of 531 spine patients who underwent full-body EOS x-rays. Correlations between CBVA, the slope of the line of sight, and McGS were assessed. Using a quadratic regression with Oswestry Disability Index and CBVA, windows of low disability were identified. Comparison of sagittal spinopelvic parameters was carried out between patients with "ascending gaze" and "neutral position." RESULTS: Three hundred three patients were included (74% female, mean age 54.8 years, body mass index 26.6 ± 6.0 kg/m 2). CBVA strongly correlated with the slope of the line of sight (r 0.996) and McGS (r 0.862). Regression studies between Oswestry Disability Index and CBVA yielded a range of values corresponding to low disability (-4.7 degrees to 17.7 degrees). Similarly, a low disability range for the slope of the line of sight (-5.1 degrees to 18.5 degrees) and McGS (-5.7 degrees to 14.3 degrees) was computed. Patients with "ascending gaze" had a worse spinopelvic alignment than "neutral position" patients. CONCLUSION: The slope of the line of sight and McGS correlated strongly with CBVA and can be used as surrogate measures. The range of values for these measures corresponding to low disability was identified. These values can be used as a general guideline to assess alignment for diagnostic purposes. Cervical compensatory mechanism may modify the natural head position in sagittally misaligned patients.

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KW - Frankfort plane

KW - Horizontal gaze

KW - McGregor slope

KW - Oswestry Disability Index

KW - Sagittal alignment

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