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

doi:10.1227/NEU.0000000000001193

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 journal › Article › peer-review

85 Scopus citations

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 language	English (US)
Pages (from-to)	108-115
Number of pages	8
Journal	Neurosurgery
Volume	79
Issue number	1
DOIs	https://doi.org/10.1227/NEU.0000000000001193
State	Published - Jul 1 2016
Externally published	Yes

Keywords

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

ASJC Scopus subject areas

Surgery
Clinical Neurology

Access to Document

10.1227/NEU.0000000000001193

Cite this

Lafage, R., Challier, V., Liabaud, B., Vira, S., Ferrero, E., Diebo, B. G., Liu, S., Vital, J. M., Mazda, K., Protopsaltis, T. S., Errico, T. J., Schwab, F. J., & 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, 79(1), 108-115. https://doi.org/10.1227/NEU.0000000000001193

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

Research output: Contribution to journal › Article › peer-review

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

@article{2495202382ac48ca8c89d968f359535f,

title = "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",

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.",

keywords = "Chin-brow vertical angle, Frankfort plane, Horizontal gaze, McGregor slope, Oswestry Disability Index, Sagittal alignment",

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

year = "2016",

month = jul,

day = "1",

doi = "10.1227/NEU.0000000000001193",

language = "English (US)",

volume = "79",

pages = "108--115",

journal = "Neurosurgery",

issn = "0148-396X",

publisher = "Lippincott Williams and Wilkins Ltd.",

number = "1",

}

TY - JOUR

T1 - Natural head posture in the setting of sagittal spinal deformity

T2 - Validation of chin-brow vertical angle, slope of line of sight, and McGregor's slope with health-related quality of life

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

PY - 2016/7/1

Y1 - 2016/7/1

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.

KW - Chin-brow vertical angle

KW - Frankfort plane

KW - Horizontal gaze

KW - McGregor slope

KW - Oswestry Disability Index

KW - Sagittal alignment

UR - http://www.scopus.com/inward/record.url?scp=84951310245&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84951310245&partnerID=8YFLogxK

U2 - 10.1227/NEU.0000000000001193

DO - 10.1227/NEU.0000000000001193

M3 - Article

C2 - 26702836

AN - SCOPUS:84951310245

SN - 0148-396X

VL - 79

SP - 108

EP - 115

JO - Neurosurgery

JF - Neurosurgery

IS - 1

ER -

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

Abstract

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this