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. 2024 Apr 24;13(9):2502.
doi: 10.3390/jcm13092502.

Sagittal Full-Spine vs. Sectional Cervical Lateral Radiographs: Are the Measurements of Cervical Alignment Interchangeable?

Jason W Haas  1 , Paul A Oakley  2 , Joseph W Betz  1   3 , Jason E Miller  1   4 , Jason O Jaeger  1   5 , Ibrahim M Moustafa  6   7 , Deed E Harrison  1
Affiliations

Sagittal Full-Spine vs. Sectional Cervical Lateral Radiographs: Are the Measurements of Cervical Alignment Interchangeable?

Jason W Haas et al. J Clin Med. .

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.

Keywords: X-ray; cervical lateral radiograph; cervical lordosis; cervical spine; neck pain; radiography; sagittal balance; whole-spine lateral radiograph.

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Conflict of interest statement

Authors J.E.M., J.O.J. and I.M.M. declare no competing interests. J.W.H. is a compensated researcher for CBP Non-Profit, Inc. P.A.O. is a compensated consultant for Chiropractic BioPhysics, NonProfit, Inc. D.E.H. is the CEO of Chiropractic BioPhysics® (CBP®) and provides post-graduate education to health care providers and physicians. Spine rehabilitation devices are distributed through his company. D.E.H. is the president of CBP Non-Profit, Inc., a not-for-profit spine research foundation.

Figures

Figure 1
Figure 1
Sagittal cervical spine radiographic variables measured with the PostureRay® software. In (A), the ARA C2-C7 measurement of cervical lordosis is shown. In (B), the translation distance of C2 relative to C7 is shown. In (C), the atlas plane line (APL) to horizontal is shown. These measurements have excellent examiner reliability [16,17].
Figure 2
Figure 2
(A) shows a sample patient full-spine lateral radiograph (FS) analyzed using the posterior tangent method with PostureRay® software. The ARA C2-C7 measurement of cervical lordosis is −7.1°, which is significantly less than the cervical lateral radiograph of the same patient in (B). (B) shows a sample lateral cervical radiograph (LC) of the same patient as in (A) above, showing a much less distorted image with greater accuracy. The ARA C2-C7 is a deeper lordosis measuring −34.6°, nearly five-fold greater than the FS measurement.
Figure 3
Figure 3
Box plots for the distribution of the absolute rotation angle (ARA C2-C7), atlas plane line (APL), and anterior head translation (AHT C2-C7) on the sectional lateral cervical (LC) radiograph compared to the full-spine (FS) lateral radiograph. The blue-shaded box represents the second and third quartiles. The lower and upper whiskers go from the minimum to the lower quartile (the inferior margin of the box) and then from the upper quartile (the top of the box) to the maximum. Units are degrees (°) for angles (ARA; APL) and millimeters (mm) for distances (AHT).
Figure 4
Figure 4
Histograms for anterior head translation (AHT) C2-C7 on the full-spine (FS) lateral versus the lateral cervical (LC) radiographs. Units are in millimeters.
Figure 5
Figure 5
Histograms for absolute rotation angle (ARA) C2-C7 for cervical lordosis on the full-spine (FS) lateral versus the lateral cervical (LC) radiographs. Units are in degrees.
Figure 6
Figure 6
Histograms for atlas plane line (APL) to horizontal for upper-cervical lordosis assessment on the full-spine (FS) lateral versus the lateral cervical (LC) radiographs. Units are in degrees.
Figure 7
Figure 7
Linear regression (with R2 value) scatter plot of anterior head translation (AHT) from C2-C7 on the sectional lateral cervical (LC) radiograph compared to the full-spine (FS) radiograph. Units are in millimeters.
Figure 8
Figure 8
Linear regression (with R2 value) scatterplot of absolute rotation angle (ARA) from C2-C7 on the sectional lateral cervical (LC) radiograph compared to the full-spine (FS) radiograph. Units are in degrees.
Figure 9
Figure 9
Linear regression (with R2 value) scatterplot of the atlas plane line (APL) to horizontal on the sectional lateral cervical (LC) radiograph compared to the full-spine (FS) radiograph. Units are in degrees.
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