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īesides WLR, cervical lateral radiograph (CLR) with arms in the neutral position (hands-on-thigh position) is another commonly used imaging modality to assess cervical sagittal parameters. The hands-on-clavicle position has been reported to distort the T1 slope, head position, or cervical lordosis, which limits its capacity to measure accurate cervical sagittal parameters. The T1 slope, a key influencing factor of cervical sagittal balance, is frequently obscured by the shoulder and thoracic trunk in the hands-on-clavicle position. However, WLR in the hands-on-clavicle position has limitations for evaluating cervical sagittal alignment. Among the many arm positions used during WLR imaging, the hands-on-clavicle position is the most widely applied position, as it provides the best visualization of thoracolumbar spine and can minimize position-related distortion of the thoracolumbar sagittal parameters. It is also commonly used to evaluate cervical sagittal parameters. Standing whole-spine lateral radiograph (WLR) is an essential imaging modality for evaluating global spine sagittal alignment. Therefore, CLR performed in the standing position seems to allow more-accurate measurements of cervical sagittal parameters. Furthermore, WLR taken in hands on clavicle position distorted radiographic measurements such as CAC2-C7 and cSVA. This study shows that standing CLR could provide better visualization of the upper endplate of T1. However, no significant differences in T1 slope, C7 slope, and CAC0–C2 were found between CLR and WLR. The mean cSVA was translated more posteriorly on WLR than on CLR (9.9 ± 18.9 mm vs 15.0 ± 13.4 mm, P =. The mean CAC2–C7 on WLR was significantly less lordotic than that on CLR (11.2 ± 9.2° vs 14.3 ± 11.3° P =. The visibility of the T1 slope was significantly lower with WLR than with CLR (28.3% vs 83.3%, P =. The following parameters were measured and analyzed: All the patients underwent standing CLR and WLR. 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). 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. The work cannot be used commercially without permission from the journal.
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This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. This study was not supported by external funding.Īll authors do not have any conflicts of interest to declare, Cervical spine lateral radiograph versus whole spine lateral radiograph: A retrospective comparative study to identify a better modality to assess cervical sagittal alignment.
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How to cite this article: Lee DH, Park S, Kim DG, Hwang CJ, Lee CS, Hwang ES, Cho JH. ∗Correspondence: Dong Gyun Kim, MD, Department of Spine Center, Haeundae Bumin Hospital 584, Haeundae-gu, Haeundae-ro, Busan, Republic of Korea (e-mail: ).Ībbreviations: CAC0–C2 = C0–C2 Cobb angle, CAC2–C7 = C2–C7 Cobb angle, cSVA = cervical sagittal vertical axis, CLR = Cervical lateral radiograph, WLR = whole-spine lateral radiograph. ADepartment of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, SeoulīDepartment of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyangsi, GyeonggidoĬDepartment of Spine Center, Haeundae Bumin Hospital, Busan, Republic of KoreaĭEmory University, College of Arts and Science, United States of America.