J Korean Soc Spine Surg.  2010 Dec;17(4):198-204. 10.4184/jkss.2010.17.4.198.

Optimal Standing Radiographic Positioning in Patients with Sagittal Imbalance

• Kim WJ

• KMID: 2209583
• DOI: http://doi.org/10.4184/jkss.2010.17.4.198

Abstract

STUDY DESIGN: This is a review of the literature about radiographic positioning for patients with sagittal imbalance.
OBJECTIVES
We wanted to verify the optimal radiographic positioning for patients with sagittal imbalance. SUMMARY OF LITERATURE REVIEW: The standing lateral whole spine radiograph for identifying the sagittal alignment has a different value for the SVA according to the radiographic positioning.
MATERIALS AND METHODS
This is a review of the literature.
RESULTS
The fists-on-the clavicle position or the cross-arm position not only represents a functional standing position, but it also causes a less negative shift of the SVA in patients with sagittal imbalance. Both the extended hip and knee positions are necessary to exclude a compensation mechanism of the lower extremity.
CONCLUSIONS
The optimal radiographic positioning is essential to examine the degrees of sagittal imbalance.

Keyword

Sagittal imbalance; Radiograph; Positioning

MeSH Terms

Clavicle
Compensation and Redress
Hip
Humans
Knee
Spine

Figure

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  Fig. 1. A 71 year old woman has lumbar lordosis and spondylolisthesis L4 on L5 in simple radiograph and MRI image(A, B). But, this patient has deformity of sagittal deformity including thoracic straightening, lumbar kyphotic change in standing lateral whole spine radiograph(C).

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  Fig. 2. The same patient has different SVA according to arm positioning

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  Fig. 3. SVA can be changed according to positioning of hip and knee joint in standing whole spine lateral radiograph of the same patient

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  Fig. 4. Thoracic kyphotic angle is measured from T4 to T12, lumbar lordotic angle L1 to S1(A). And C7 plumb line is lined from center of C7 body and SVA can be measured as distance between C7 plumb line and postero-superior corner of S1 vertebral body(B). Also pelvic parameters such as pelvic incidence, sacral slope, and pelvic tilt can be measured in standing lateral whole spine(C).

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  Fig. 5. Fists-on-clavicle(A, B) or cross-arm position(C, D) is recommended with extended hip and knee during taking radiographs.

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