| ObjectiveThe lateral X-ray radiograph in standing position was widely used in the evaluation of the cervical sagittal sequence.Compared with the sagittal image of the cervical spine in the supine position,the standing position can truly reflect the physiological curvature of the cervical spine.However,covered by the joints of the shoulders and soft tissues of the neck,on the common lateral X-ray image of the cervical spine,some patients could not clearly show the upper endplate of the first thoracic vertebrae and the upper edge of the sternum.To overcome this shortcoming,in this study,the lateral radiograph of the cervical spine was taken by X-ray tomography fusion image technique,and the MRI image of the cervical spine was taken at the same time.To compare and analyze the difference and correlation of cervical spine sagittal parameters between the cervical spine tomography fusion images and the MRI sagittal images,and explain their clinical significance.MethodRetrospective analysis of 106 patients(56 males and 50 females;aged 28 to 65 years,mean age 52.8 ± 8.0 years old)who underwent cervical lateral tomography fusion images and MRI sagittal images due to cervical symptoms in the Department of Orthopaedic,First Affiliated Hospital of Zhengzhou University from January 2018 to December 2018;lateral cervical tomography fusion images and MRI sagittal T2-weighted images were used to measure 0-C2 angle(Cobb0-C2)、 C2-C7 angle(CobbC2-7)、C2-C7 sagittal vertical axis(C2-7SVA)、T1 slope(T1S)、 neck tilt(NT)、thoracic inlet angle(TIA),respectively.Connect the midpoint A of the lower endplate of the second cervical vertebrae and the midpoint B of the upper endplate of the seventh cervical vertebrae,according to the positions of the vertebral centroids relative to line AB in the radiographs,the alignment was classified into lordosis and kyphosis groups.The lordosis group was defined as the group in which all vertebral centroids were anterior to line AB.The kyphotic group was defined as the group in which at least one of the centroids was posterior to line AB.Paired t-test,Pearson correlation coefficient and linear regression analysis were used to compare the differences and correlations of the measured results between and within groups.ResultsAmong the parameters measured on the cervical X-ray tomographic fusion images and MRI median sagittal plane images,there were no significant differences between TIAX and TIAM,kyphosis CobbC2-7X and kyphosis CobbC2-7M(P>0.05);there were significant statistical differences between CobbO-C2 X and CobbO-C2 M,the overall CobbC2-7X and the overall CobbC2-C7 M,lordosis CobbC2-7X and lordosis CobbC2-C7 M,C2-7SVAX and C2-7SVAM,T1 SX and T1 SM,NTX and NTM(P<0.05).In the datas measured on the standing cervical lateral images,there were strong positive correlations between TIAX and T1SX(r=0.554),TIAX and NTX(r=0.760),T1 SX and CobbC2-7X(r=0.674),and there were significant statistical differences.CobbO-C2 X had a negative correlation with CobbC2-7X(r=-0.416),and there was a significant statistical difference.In the datas measured on the MRI median sagittal plane images,there were strong positive correlations between TIAM and T1SM(r=0.502),TIAM and NTM(r=0.761),T1 SM and CobbC2-7M(r=0.512),and there were significant statistical differences.Between the cervical X-ray tomographic fusion images and MRI median sagittal plane images,there were strong positive correlations between CobbO-C2 X and CobbO-C2 M,CobbC2-7X and CobbC2-7M,TIAX and TIAM,NTX and NTM,T1 SX and T1 SM.The r values were 0.835,0.912,0.950,0.844,and 0.744,respectively,and there were significant statistical differences.Conclusion1.The use of cervical X-ray tomography fusion image technique to capture a clear standing cervical lateral radiograph is more suitable for the measurement of cervical sagittal sequence parameters.2.It is inaccurate to use the supine position to evaluate the sagittal alignment of the cervical spine instead of the standing cervical lateral image. |
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