Cervical spine lateral radiograph versus whole spine lateral radiograph: A retrospective comparative study to identify a better modality to assess cervical sagittal alignment

• Type of Material: Article
• Authors: Dong-Ho Lee, University of Ulsan College of Medicine; Sehan Park, Dongguk University Ilsan Hospital; Dong Gyun Kim, Haeundae Bumin Hospital; Chang Ju Hwang, University of Ulsan College of Medicine; Choon Sung Lee, University of Ulsan College of Medicine; Eui Seung Hwang, Emory University; Jae Hwan Cho, University of Ulsan College of Medicine
• Language: English
• Date: 2021-05-28
• Publisher: Wolters Kluwer Health, Inc.
• Publication Version: Final Published Version
• Copyright Statement: © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1097/MD.0000000000025987
• Title of Journal or Parent Work: Medicine
• Volume: 100
• Issue: 21
• Start Page: e25987
• End Page: e25987
• Grant/Funding Information: This study was not supported by external funding.
• Keywords: Female; Retrospective Studies; Male; Cervical Vertebrae; Middle Aged; Radiography; Adult; Humans; Aged
• Research Categories: Health Sciences, Medicine and Surgery

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.