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Haas JW, Oakley PA, Betz JW, Miller JE, Jaeger JO, Moustafa IM, Harrison DE. Sagittal Full-Spine vs. Sectional Cervical Lateral Radiographs: Are the Measurements of Cervical Alignment Interchangeable? J Clin Med 2024; 13:2502. [PMID: 38731030 PMCID: PMC11084776 DOI: 10.3390/jcm13092502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/18/2024] [Accepted: 04/18/2024] [Indexed: 05/13/2024] Open
Abstract
(1) Background: This study assessed the relationship between cervical spine parameters taken on standing full-spine lateral radiographic images compared to sectional lateral cervical radiographs. (2) Methods: Full-spine (FS) and sectional lateral cervical (LC) radiographs from four spine treatment facilities across the USA retrospectively provided data collected on 220 persons to assess the comparison of three sagittal cervical radiographic measurements between the two views. The measures included cervical lordosis using the absolute rotation angle from C2-C7, sagittal cervical translation of C2-C7, and atlas plane angle to horizontal. Linear correlation and R2 models were used for statistical comparison of the measures for the two views. (3) Results: The mean values of the three measurements were statistically different from each other: C2-C7 translation (FS = 19.84 ± 11.98 vs. LC = 21.18 ± 11.8), C2-C7 lordosis (FS = -15.3 ± 14.63 vs. LC = -18.32 ± 13.16), and atlas plane (FS = -19.99 ± 8.88 vs. LC = -22.56 ± 8.93), where all values were p < 0.001. Weak-to-moderate-to-strong correlations existed between the full-spine and sectional lateral cervical radiographic variables. The R2 values varied based on the measurement were R2 = 0.768 (p < 0.001) for sagittal cervical translation of C2-C7 (strong), R2 = 0.613 (p < 0.001) for the absolute rotation angle C2-C7 (moderate), and R2 = 0.406 (p < 0.001) for the atlas plane line (weak). Though a linear correlation was identified, there were consistent intra-person differences between the measurements on the full spine versus sectional lateral cervical radiographic views, where the full-spine view consistently underestimated the magnitude of the variables. (4) Conclusion: Key sagittal cervical radiographic measurements on the full spine versus sectional lateral cervical radiographic views show striking intra-person differences. The findings of this study confirm that full spine versus sectional lateral cervical radiographic views provide different biomechanical magnitudes of cervical sagittal alignment, and caution should be exercised by health care providers as these are not interchangeable. We recommend the LC view for measurement of cervical sagittal alignment variables.
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Affiliation(s)
- Jason W. Haas
- CBP NonProfit, Inc., Eagle, ID 83616, USA; (J.W.H.); (J.W.B.); (J.E.M.); (J.O.J.)
| | - Paul A. Oakley
- Kinesiology and Health Science, York University, Toronto, ON M3J 1P3, Canada;
| | - Joseph W. Betz
- CBP NonProfit, Inc., Eagle, ID 83616, USA; (J.W.H.); (J.W.B.); (J.E.M.); (J.O.J.)
- Private Practice, Boise, ID 83709, USA
| | - Jason E. Miller
- CBP NonProfit, Inc., Eagle, ID 83616, USA; (J.W.H.); (J.W.B.); (J.E.M.); (J.O.J.)
- Private Practice, Lakewood, CO 80226, USA
| | - Jason O. Jaeger
- CBP NonProfit, Inc., Eagle, ID 83616, USA; (J.W.H.); (J.W.B.); (J.E.M.); (J.O.J.)
- Community Based Internship Program, Associate Faculty, Southern California University of Health Sciences, Whittier, CA 90604, USA
| | - Ibrahim M. Moustafa
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
- Neuromusculoskeletal Rehabilitation Research Group, RIMHS–Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Deed E. Harrison
- CBP NonProfit, Inc., Eagle, ID 83616, USA; (J.W.H.); (J.W.B.); (J.E.M.); (J.O.J.)
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Lee DH, Park S, Kim DG, Hwang CJ, Lee CS, Hwang ES, Cho JH. Cervical spine lateral radiograph versus whole spine lateral radiograph: A retrospective comparative study to identify a better modality to assess cervical sagittal alignment. Medicine (Baltimore) 2021; 100:e25987. [PMID: 34032714 PMCID: PMC8154400 DOI: 10.1097/md.0000000000025987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/28/2021] [Indexed: 01/04/2023] Open
Abstract
This study is aimed to compare whole-spine lateral radiograph (WLR) and cervical lateral radiograph (CLR) in terms of T1 slope visibility and cervical sagittal parameters and to identify the superior imaging modality for assessment of cervical sagittal parameters. We retrospectively reviewed the radiographic data of 60 consecutive adult patients (male-to-female ratio, 38:22; mean age, 55.6 ± 1.3 years) who presented with only neck pain (without radiculopathy or myelopathy). All the patients underwent standing CLR and WLR. The following parameters were measured and analyzed: 1. T1 slope visibility, 2. T1 slope, 3. C7 slope, 4. C0–C2 Cobb angle (CAC0–C2), 5. C2–C7 Cobb angle (CAC2–C7), and 6. cervical sagittal vertical axis (cSVA). The visibility of the T1 slope was significantly lower with WLR than with CLR (28.3% vs 83.3%, P = .049). The mean CAC2–C7 on WLR was significantly less lordotic than that on CLR (11.2 ± 9.2° vs 14.3 ± 11.3°; P = .01). The mean cSVA was translated more posteriorly on WLR than on CLR (9.9 ± 18.9 mm vs 15.0 ± 13.4 mm, P = .04). However, no significant differences in T1 slope, C7 slope, and CAC0–C2 were found between CLR and WLR. This study shows that standing CLR could provide better visualization of the upper endplate of T1. Furthermore, WLR taken in hands on clavicle position distorted radiographic measurements such as CAC2-C7 and cSVA. Therefore, CLR performed in the standing position seems to allow more-accurate measurements of cervical sagittal parameters.
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Affiliation(s)
- Dong-Ho Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Sehan Park
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyangsi, Gyeonggido
| | - Dong Gyun Kim
- Department of Spine Center, Haeundae Bumin Hospital, Busan, Republic of Korea
| | - Chang Ju Hwang
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Choon Sung Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Eui Seung Hwang
- Emory University, College of Arts and Science, United States of America
| | - Jae Hwan Cho
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul
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Lee SH, Hyun SJ, Jain A. Cervical Sagittal Alignment: Literature Review and Future Directions. Neurospine 2020; 17:478-496. [PMID: 33022153 PMCID: PMC7538362 DOI: 10.14245/ns.2040392.196] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/13/2020] [Indexed: 12/26/2022] Open
Abstract
Cervical alignment as a concept has come to the forefront for spine deformity research in the last decade. Studies on cervical sagittal alignment started from normative data, and expanded into correlation with global sagittal balance, prognosis of various conditions, outcomes of surgery, definition and classification of cervical deformity, and prediction of targets for ideal cervical reconstruction. Despite the recent robust research efforts, the definition of normal cervical sagittal alignment and cervical spine deformity continues to elude us. Further, many studies continue to view cervical alignment as a continuation of thoracolumbar deformity and do not take into account biomechanical features unique to the cervical spine that may influence cervical alignment, such as the importance of musculature connecting cranium-cervical-thoracic spine and upper extremities. In this article, we aim to summarize the relevant literature on cervical sagittal alignment, discuss key results, and list potential future direction for research using the '5W1H' framework; "WHO" are related?, "WHY" important?, "WHAT" to evaluate and "WHAT" is normal?, "HOW" to evaluate?, "WHEN" to apply sagittal balance?, and "WHERE" to go in the future?
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Affiliation(s)
- Sang Hun Lee
- Department of Orthopaedic Surgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Seung-Jae Hyun
- Department of Neurological Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Amit Jain
- Department of Orthopaedic Surgery, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
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Morimoto Y, Shigematsu H, Iwata E, Tanaka M, Okuda A, Masuda K, Yamamoto Y, Takeshima T, Nakagawa Y, Tanaka Y. Evaluating Cervical Sagittal Alignment in Cervical Myelopathy: Are Sitting Cervical Radiographs and Standing Whole-Spine Radiographs Equally Useful? Global Spine J 2019; 9:591-597. [PMID: 31448191 PMCID: PMC6693062 DOI: 10.1177/2192568218811841] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
STUDY DESIGN Retrospective review of medical charts and radiographic data. OBJECTIVES We aimed to clarify the differences in cervical alignment findings between sitting cervical lateral radiographs and standing whole-spine lateral radiographs with clavicle positioning in cervical spondylotic myelopathy (CSM) patients. METHODS We retrospectively evaluated the radiographs of 50 consecutive patients who underwent cervical surgery for CSM in our hospital. Cervical sagittal alignment was evaluated based on the C0-2 angles and C2-7 Gore and Cobb angles. Head position was evaluated in terms of the center of gravity of the head to C7 (CGH-C7) angle and the McGregor angle (ie, the angle between the McGregor line and a horizontal line). The T1-slope was also evaluated. RESULTS The mean values of the CGH-C7 angle and T1-slope were significantly lower, while the mean value of the McGregor angle was significantly higher on whole-spine lateral radiographs with clavicle positioning than on sitting cervical lateral radiographs. The mean values of the C0-2 and C2-7 angles did not differ significantly between the 2 radiographic positioning approaches. CONCLUSIONS Using whole-spine lateral radiographs with clavicle positioning may result in a significantly lower T1-slope and a posterior tilt of the head. In the absence of a compensatory change in cervical alignment, clavicle positioning may force patients to adopt an upward gazing position of the head. These compensatory mechanisms should be considered while evaluating cervical alignment on whole-spine lateral radiographs with clavicle positioning. Surgical planning should take into account the effect of posture on the radiographic appearance of cervical alignment.
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Affiliation(s)
- Yasuhiko Morimoto
- Nara Medical University, Kashihara City, Nara, Japan,Uda City Hospital, Uda City, Nara, Japan
| | - Hideki Shigematsu
- Nara Medical University, Kashihara City, Nara, Japan,Hideki Shigematsu, Department of Orthopedic Surgery,
Nara Medical University, 840 Shijo-cho, Kashihara City, Nara 634-8522, Japan.
| | | | - Masato Tanaka
- Nara Medical University, Kashihara City, Nara, Japan
| | - Akinori Okuda
- Nara Medical University, Kashihara City, Nara, Japan
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Oshina M, Tanaka M, Oshima Y, Tanaka S, Riew KD. Correlation and differences in cervical sagittal alignment parameters between cervical radiographs and magnetic resonance images. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:1408-1415. [DOI: 10.1007/s00586-018-5550-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 02/14/2018] [Accepted: 03/13/2018] [Indexed: 10/17/2022]
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Comparative Analysis of Three Imaging Modalities for Evaluation of Cervical Sagittal Alignment Parameters: A Validity and Reliability Study. Spine (Phila Pa 1976) 2017; 42:1901-1907. [PMID: 28574884 DOI: 10.1097/brs.0000000000002256] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This was a radiologic validity and reliability study. OBJECTIVE We aimed to assess the validity and reliability of measurements from standing lateral cervical radiography (XR), reconstructed midsagittal images of supine cervical computerized tomography (CT) scans, and supine magnetic resonance imaging (MRI) for evaluating C2-C7 distance (C27 SVA), C2-C7 Cobb angle (CL), T1 slope (T1S), thoracic inlet angle (TIA), and neck tilt (NT). SUMMARY OF BACKGROUND DATA XR is the criterion standard imaging modality for measuring cervical sagittal alignment parameters. However, overlapping bony structures and soft tissue often make the upper end of the manubrium and cervicothoracic junction indiscernible. CT and MRI can overcome this limitation, but their reliability and validity have not been fully elucidated. METHODS Fifty sets of three examinations from our database have been randomly selected. Three experienced spinal surgeons independently measured C27 SVA, CL, T1S, TIA, and NT. Paired t test and Pearson correlation were used to analyze the validity of CT and MRI in comparison with that of XR. Interobserver and intraobserver reliability were assessed by using the intraclass correlation coefficient (ICC). RESULTS The paired t test confirmed the similarities of all CT (except C27 SVA) and MR parameters (except C27 SVA and CL) to the XR parameters (all P > 0.05). All parameters except C27 SVA were correlated (Pearson correlation coefficient, 0.523-0.913). Correlation was highest between CT and MRI and lowest between CT and XR. All three imaging modalities had excellent intraobserver and interobserver reliability (ICC range: 0.770-0.999). Intraobserver and interobserver reliability were highest with MRI and lowest with XR. CONCLUSION CT and especially MRI were more reliable than XR for evaluating cervical sagittal alignment parameters. Considering the reliability and radiation exposure, MRI is a good alternative to XR for measuring cervical sagittal alignment parameters, especially thoracic inlet alignment. LEVEL OF EVIDENCE 4.
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Yang Z, Xie F, Zhang J, Liang Z, Wang Z, Hu X, Luo Z. An analysis of radiographic parameters comparison between lumbar spine latericumbent and full-length lateral standing radiographs. Spine J 2017; 17:1812-1818. [PMID: 28694216 DOI: 10.1016/j.spinee.2017.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 05/11/2017] [Accepted: 06/05/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The lumbar spine latericumbent and full-length lateral standing radiographs are most commonly used to assess lumbar disorder. However, there are few literatures on the difference and correlation of the sagittal parameters between the two shooting positions. PURPOSE The study aimed to investigate the difference of sagittal parameters in spine lateral radiographs between latericumbent and upright positions, identify the correlation, and establish a preliminary linear fitting formula. STUDY DESIGN The study is a prospective study on radiographic evaluation of sagittal alignment using latericumbent and upright positions. PATIENT SAMPLE One hundred fifty-seven patients were recruited from the orthopedics clinic of a single medical center. OUTCOME MEASURE Angle measurement, the intra- and interobserver measurement reliability of measurement, and analysis of the angle measurement were carried out. METHOD The sagittal alignment of 157 patients were assessed using Surgimap software from two kinds of lateral radiographs to acquire the following parameters: lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), L4-L5 intervertebral angle (IVA4-5), L4-L5 intervertebral height index (IHI4-5), and PI-LL. The Kolmogorov-Smirnov test, paired t test, Pearson correlation analysis, and multivariate linear regression analysis were used to analyze the data. RESULTS The results showed significantly statistical difference in LL, SS, PT, IVA4-5, and PI-LL, except for PI and IHI4-5, between the two positions. There was a significant relativity between standing LL and latericumbent LL (r=0.733, p<.01), PI (r=0.611, p<.01), and SS (r=0.626, p<.01). The predictive formula of standing LL was 12.791+0.777 latericumbent LL+0.395 latericumbent PI-0.506 latericumbent SS (adjusted R2=0.619, p<.05). CONCLUSION Not all of sagittal parameters obtained from two positions are identical. Thus, the full-spine lateral standing films are difficult to be replaced. The surgeon should give sufficient consideration to the difference between the two views. We may primarily predict standing LL with the formula when we could not get whole-spine lateral standing radiographs.
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Affiliation(s)
- Zhiwei Yang
- Department of Orthopaedics, Xijing Hospital, Fourth Military Medical University, No. 127 Changle West Rd, Xi'an, Shaanxi 710032, China
| | - Fang Xie
- Department of Orthopaedics, Xijing Hospital, Fourth Military Medical University, No. 127 Changle West Rd, Xi'an, Shaanxi 710032, China
| | - Jianxin Zhang
- Department of Orthopaedics, Xijing Hospital, Fourth Military Medical University, No. 127 Changle West Rd, Xi'an, Shaanxi 710032, China
| | - Zhuowen Liang
- Department of Orthopaedics, Xijing Hospital, Fourth Military Medical University, No. 127 Changle West Rd, Xi'an, Shaanxi 710032, China
| | - Zhe Wang
- Department of Orthopaedics, Xijing Hospital, Fourth Military Medical University, No. 127 Changle West Rd, Xi'an, Shaanxi 710032, China
| | - Xueyu Hu
- Department of Orthopaedics, Xijing Hospital, Fourth Military Medical University, No. 127 Changle West Rd, Xi'an, Shaanxi 710032, China.
| | - Zhuojing Luo
- Department of Orthopaedics, Xijing Hospital, Fourth Military Medical University, No. 127 Changle West Rd, Xi'an, Shaanxi 710032, China.
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My Crooked and Aching Neck-Surgical Management of Cervical Deformity. World Neurosurg 2016; 91:644-6. [PMID: 27188641 DOI: 10.1016/j.wneu.2016.05.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 05/09/2016] [Indexed: 11/21/2022]
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