J Korean Soc Spine Surg.  2020 Jun;27(2):48-54. 10.4184/jkss.2020.27.2.48.

Relationships and Usefulness of Cervical Lateral Radiographs Compared with Whole-Spine Lateral Radiographs for Evaluating Cervical Sagittal Alignment

  • 1Department of Orthopedic Surgery, Inje University, Haeundae Paik Hospital, Busan, Korea


Study Design: Retrospective analysis.
This study was conducted to identify the correlations and usefulness of lateral cervical radiographs compared with wholespine sagittal lateral radiographs for evaluating cervical sagittal alignment. Summary of Literature Review: Few reports have compared cervical lateral radiographs with whole-spine sagittal radiographs.
Materials and Methods
We retrospectively analyzed 181 patients with both cervical standing lateral radiographs and whole-spine standing lateral radiographs. The radiographs were evaluated using the following sagittal alignment parameters: C2-7 lordosis, C2-7 sagittal vertical axis (SVA), T1 slope, spino-cranial angle (SCA), and whole-spine SVA. We evaluated the relationships between the two radiographs. The patients were divided into four groups according to age and the measured sagittal parameters were compared across groups. An analysis according to clinical symptoms was also done.
C2-7 lordosis was 16.86° and 15.76°, C2-7 SVA was 15.76° and 16.86°, T1 slope was 29.03° and 22.49°, and SCA was 74.74° and 74.5°, respectively, on the cervical and whole spine radiographs. The whole-spine SVA was -2.64 mm. Correlation analysis between the two types of radiographs showed significant relationships for each sagittal parameter. The whole-spine SVA was related with wholespine C2-7 lordosis, T1 slope, and SCA. Cervical C2-7 lordosis and the whole-spine SVA increased with age. A decrease of C2-7 lordosis on whole-spine radiographs was shown in patients with neck pain.
Cervical SVA and T1 slope were lower on whole-spine standing lateral radiographs than on simple cervical lateral radiographs. The cervical sagittal parameters measured on cervical radiographs were correlated with those measured on whole-spine radiographs. Cervical radiographs can be used to replace whole-spine radiographs with due consideration of these findings.


Cervical sagittal alignment; Whole spine radiographs; Cervical lateral radiographs; Correlation; Usefulness
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