Open Access, Peer-reviewed
pISSN 2093-4378
eISSN 2093-4386
    J Korean Soc Spine Surg. 2020 Dec;27(4):125-130. Korean.
    Published online Dec 31, 2020.
    https://doi.org/10.4184/jkss.2020.27.4.125
    © Copyright 2020 Korean Society of Spine Surgery
    Original Article

    Efficacy of Dynamic Radiographs in Routine Evaluations for Degenerative Cervical Spine Disease

    Chung-Shik Shin, M.D., Jin-Hong Kim, M.D., Kyung-Jin Song, M.D. and Byung-Wan Choi, M.D.*
      • Department of Orthopedic Surgery, Presbyterian Medical Center, Jeon-Ju, Korea.
      • *Department of Orthopedic Surgery, Inje University, Haeundae Paik Hospital, Busan, Korea.
    • Corresponding author: Byung Wan Choi, M.D. Department of Orthopedic Surgery, Inje University, Haeundae Paik Hospital 875, Haeundae-ro, Haeundae-gu, Busan 48108, Korea. TEL: +82-51-797-0240, FAX: +82-51-797-0249, Email: alla1013@naver.com
    Received August 31, 2020; Revised August 31, 2020; Accepted November 27, 2020.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    Abstract

    Study Design

    Retrospective study.

    Objectives

    To analyze the usefulness of flexion-extension radiographs in the diagnosis of degenerative cervical disease.

    Summary of Literature Review

    There is little information about the efficacy of flexion-extension radiographs in the diagnosis of degenerative cervical disease.

    Methods and Materials

    We analyzed 1,062 patients with cervical degenerative disease who underwent flexion-extension radiographs and computed tomography (CT) or magnetic resonance imaging (MRI). The range of motion of the cervical joints was measured. Segmental instability was evaluated using the sagittal translation (≥3.5 mm) between C2 and T1, the sagittal angulation (≥3.5°), the vertebral slip angle (≥ 10°), and the dynamic spinal canal stenosis (≤12 mm). The relationship between canal compromise on CT or MRI and radiological instability was also evaluated.

    Results

    Cervical range of motion was 36.45°±17.63° (range, 2.1°–106.6°). Segmental instability was observed in 484 patients (nine cases of sagittal translation, 79 cases of sagittal plane rotation, 415 cases of a vertical slip angle, and 21 cases of dynamic spinal stenosis). Segmental instability was related with pathology in 218 patients with available CT or MRI (42%, including five cases of sagittal translation, 32 cases of sagittal plane rotation, 171 cases of vertical slip angle, and 10 cases of dynamic spinal stenosis.

    Conclusions

    Flexion-extension radiographs of the cervical spine were useful in diagnosing and evaluating subaxial segmental instability.

    Keywords
    Cervical spine disease; Segmental instability; Synamic radiographs

    Figures

    Fig. 1
    Radiographic parameters (a. diagrams and b. actual measurements). (A) Sagittal translation, (B) Sagittal angulation, (C) Vertebral slip angle, (D) Dynamic spinal canal stenosis.

    Tables

    Table 1
    Demographic characteristics of segmental instability cases

    Table 2
    Segmental instability of each level

    Table 3
    Relationship between segmental instability and final diagnosis

    Acknowledgements

    This work was supported by grant from Inje University in 2019.

    References

      1. Uchida K, Nakajima H, Sato R, Yayama T, Mwaka ES, Kobayashi S, Baba H. Cervical spondylotic myelopathy associated with kyphosis or sagittal sigmoid alignment: outcome after anterior or posterior decompression. J Neurosurg Spine 2009 Nov;11(5):521–528. [doi: 10.3171/2009.2.SPINE08385]
      1. Khan SN, Erickson G, Sena MJ, Gupta MC. Use of flexion and extension radiographs of the cervical spine to rule out acute instability in patients with negative computed tomography scans. J Orthop Trauma 2011 Jan;25(1):51–56. [doi: 10.1097/BOT.0b013e3181dc54bf]
      1. Insko EK, Gracias VH, Gupta R, Goettler CE, Gaieski DF, Dalinka MK. Utility of flexion and extension radiographs of the cervical spine in the acute evaluation of blunt trauma. J Trauma 2002 Sep;53(3):426–429. [doi: 10.1097/00005373-200209000-00005]
      1. Wang JC, Hatch JD, Sandhu HS, Delamarter RB. Cervical flexion and extension radiographs in acutely injured patients. Clin Orthop Relat Res 1999;(365):111–116. [doi: 10.1097/00003086-199908000-00015]
      1. Johnson MJ, Lucas GL. Value of cervical spine radiographs as a screening tool. Clin Orthop Relat Res 1997 Jul;(340):102–108. [doi: 10.1097/00003086-199707000-00014]
      1. Yang KH, Kim NK, Kim YS, Ko Y, Oh SH, Oh SJ, Kim KM. Lumbar Spinal Instability and Its Radiologic Findings. J Korean Neurosurg Soc 2000;29(1):78–86.
      1. Chung JY, Kim SK, Jung ST, Lee KB, Seo HY, Hu CY, Park GH. Spontaneous reduction finding: magnetic resonance imaging evaluation of segmental instability in spondylolisthesis. Asian Spine J 2012 Dec;6(4):221–226. [doi: 10.4184/asj.2012.6.4.221]
        Epub 2012 Dec 14.
      1. Choi BW, Kim SS, Lee DH, Kim JW. Cervical radiculopathy combined with cervical myelopathy: prevalence and characteristics. Eur J Orthop Surg Traumatol 2017 Oct;27(7):889–893. [doi: 10.1007/s00590-017-1972-2]
      1. Grob D, Dvorak J, Panjabi MM, Antinnes JA. [External fixator of the cervical spine-a new diagnostic tool]. Unfallchirurg 1993 Aug;96(8):416–421.
      1. Ebraheim NA, Xu R, Ahmad M, Heck B, Yeasting RA. The effect of anterior translation of the vertebra on the canal size in the lower cervical spine: a computer-assisted anatomic study. J Spinal Disord 1997 Apr;10(2):162–166.
      1. Wang B, Liu H, Wang H, Zhou D. Segmental instability in cervical spondylotic myelopathy with severe disc degeneration. Spine (Phila Pa 1976) 2006 May;31(12):1327–1331. [doi: 10.1097/01.brs.0000218508.86258.d4]
      1. White AA III, Panjabi MM. The problem of clinical instability in the human spine: a systemic approach. In: White AA III, Panjabi MM, editors. Clinical Biomechanics of the spine. Philadelphia: JB Lippincott Company; 1978. pp. 191-272.
      1. Marion DW, Dommeier R, Dunham CM. Determination of cervical spine instability in trauma patients. Eastern Association for the surgery of trauma; [Accessed November 18, 2000].
      1. Feipel V, Rondelet B, Le Pallec J, Rooze M. Normal global motion of the cervical spine: an electrogoniometric study. Clin Biomech (Bristol, AvAvon) 1999 Aug;14(7):462–470. [doi: 10.1016/s0268-0033(98)90098-5]
      1. White APAP, Biswas D, Smart LR, Haims A, Grauer JN. Utility of flexion-extension radiographs in evaluating the degenerative cervical spine. Spine (Phila Pa 1976) 2007 Apr;32(9):975–979. [doi: 10.1097/01.brs.0000261409.45251.a2]
      1. Kim CH, Hwang JM, Park JS, Han S, Park D. Predictability of severity of disc degeneration and disc protrusion using horizontal displacement of cervical dynamic radiographs: A retrospective comparison study with MRI. Medicine (Baltimore) 2018 Jun;97(25):e11098 [doi: 10.1097/MD.0000000000011098]
    MeSH Terms
    Cervical Vertebrae*
    Constriction, Pathologic
    Diagnosis
    Female
    Humans
    Joints
    Magnetic Resonance Imaging
    Pathology
    Range of Motion, Articular
    Retrospective Studies
    Spinal Canal
    Spinal Stenosis
    Metrics
    Share
    Figures
    slide

    1 / 1

    Tables
    slide
    slide
    slide

    1 / 3

    ORCID IDs
    Funding Information
    PERMALINK