Functional division and age differences in cervical spine of males and females

Abstract

Introduction. The cervical spine from osteopathy point of view, taking into account spine functional division, includes vertebrae of the cervical-thoracic junction, and the approach requires additional coordination. The X-ray examination experience with the entire spine integrity suggests that both cervical vertebrae and vertebrae of cervical-thoracic junction are the place of the greatest age-related changes. The study of gender difference in cervical spine vertebra positions and its age-related dynamics requires additional attention. The purpose of the work: on the basis of digital radiographs to develop an integral indicator for assessing the position of the vertebrae of the middle cervical spine; research objectives: to quantify vertebra positions from CIII–VI; to propose a characteristic of transition smoothness from vertebral CIII–VI group to the vertebral CVII–TIII group; to study the male/female features of age trend in cervical spine shape.Materials and methods. Radiographs of all spine parts in sagittal plane were examined for 141 patients with dorsopathies (57 males and 84 females). The cohort of patients is divided into 4 groups: I (n=31) — 21–44 years (average age 33,1 years); II (n=39) — 45–59 years (average age 52,6 years); III (n=50) — 60–74 years (average age 66,8 years); IV (n=21) — 75–88 years (average age 81,1 years). A single digital X-ray spine image in sagittal plane was obtained for each patient. On the combined digital radiograph, the occipital vertical was drawn along all spine parts, starting from the external tubercle of occipital bone, and anteroposterior axes for CIII–TIII vertebrae (r axes) were drawn. The angles between the occipital vertical and the perpendiculars restored to the axes at the points of their intersection with the occipital vertical were measured. Statistical processing of the data obtained was carried out.Results. The St integral indicator has been developed to quantify the vertebra position of middle cervical spine. It was calculated by formula St = (rCIII+rCIV+rCV +rCVI)/4. Using St the type boundaries are determined, and four displacement types for the cervical vertebra group (from CIII–VI) are identifi ed: I — low start; II — medium start; III — high start; IV — ultra-high start. An age-related trend of changes in CIII–VI vertebra position was detected. The correlation between the position indicator St of the middle cervical vertebrae and indicator ArCT for the vertebrae of cervical-thoracic junction CVII–TIII was proved. Gender differences depending on age were revealed in transition smoothness between these spine parts.Conclusion. Some arguments have been obtained confi rming the validity of attributing the vertebra group of cervical-thoracic junction from CVII to TIII to the functional unity of cervical spine. Quantitative smoothness assessment of transition from the middle cervical spine to the vertebra group of cervical-thoracic junction can be carried out by calculating the difference between the ArCT and St indicators. The difference demonstrates age-related shape features of the spine part for males and females.