Skip to main content
Top
Published in: Journal of Orthopaedic Surgery and Research 1/2014

Open Access 01-12-2014 | Research article

Evaluation of occipitocervical neutral position using lateral radiographs

Authors: Jiangwei Tan, Guangjun Liao, Shaoxian Liu

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2014

Login to get access

Abstract

Background

Intraoperative assessment of neutral occipitocervical balance during a fusion procedure is challenging. We designed this study to introduce a more comprehensive method of evaluating the occipitocervical neutral position using lateral radiographs.

Methods

One hundred neutral lateral cervical spine radiographs interpreted as normal were studied. Cervical spine radiographs were performed using a standard technique. The occipitocervical angle, the occipitocervical distance, and the mandible cervical distance were measured by different observers.

Results

A difference analysis was performed between males and females. The mean mandible cervical distances were 11.0 and 11.2 mm in males and females, respectively. The mean occipitocervical distances were 22.0 mm (male) and 19.6 mm (female), and the occipitocervical angles were 47.2° (male) and 45.5° (female). The occipitocervical distance revealed significant differences between males and females (p <0.01). However, there were no significant differences between sexes for the occipitocervical angle or the mandible cervical distance (p >0.01).

Conclusions

This study offers reference values for the occipitocervical angle and occipitocervical distance for the estimation of the occipitocervical neutral position. The introduction of the mandible cervical distance may make the evaluation more direct and more comprehensive during surgery because of its sensitivity to changes in head position.
Appendix
Available only for authorised users
Literature
1.
go back to reference Lee SC, Chen JF, Lee ST: Clinical experience with rigid occipitocervical fusion in the management of traumatic upper cervical spinal instability. J Clin Neurosci. 2006, 13: 193-198. 10.1016/j.jocn.2005.03.031.CrossRefPubMed Lee SC, Chen JF, Lee ST: Clinical experience with rigid occipitocervical fusion in the management of traumatic upper cervical spinal instability. J Clin Neurosci. 2006, 13: 193-198. 10.1016/j.jocn.2005.03.031.CrossRefPubMed
2.
go back to reference Shin H, Barrenechea IJ, Lesser J, Sen C, Perin NI: Occipitocervical fusion after resection of craniovertebral junction tumors. J Neurosurg Spine. 2006, 4: 137-144. 10.3171/spi.2006.4.2.137.CrossRefPubMed Shin H, Barrenechea IJ, Lesser J, Sen C, Perin NI: Occipitocervical fusion after resection of craniovertebral junction tumors. J Neurosurg Spine. 2006, 4: 137-144. 10.3171/spi.2006.4.2.137.CrossRefPubMed
3.
go back to reference Nakagawa T, Yone K, Sakou T, Yanase M: Occipitocervical fusion with C1 laminectomy in children. Spine. 1997, 22: 1209-1214. 10.1097/00007632-199706010-00006.CrossRefPubMed Nakagawa T, Yone K, Sakou T, Yanase M: Occipitocervical fusion with C1 laminectomy in children. Spine. 1997, 22: 1209-1214. 10.1097/00007632-199706010-00006.CrossRefPubMed
4.
go back to reference Rodgers WB, Coran DL, Emans JB, Hresko MT, Hall JE: Occipitocervical fusions in children. Retrospective analysis and technical considerations. Clin Orthop Relat Res. 1999, 364: 125-133. 10.1097/00003086-199907000-00017.CrossRefPubMed Rodgers WB, Coran DL, Emans JB, Hresko MT, Hall JE: Occipitocervical fusions in children. Retrospective analysis and technical considerations. Clin Orthop Relat Res. 1999, 364: 125-133. 10.1097/00003086-199907000-00017.CrossRefPubMed
5.
go back to reference Kim LJ, Rekate HL, Klopfenstein JD, Sonntag VK: Treatment of basilar invagination associated with Chiari I malformations in the pediatric population: cervical reduction and posterior occipitocervical fusion. J Neurosurg. 2004, 101 (Suppl 2): 189-195.PubMed Kim LJ, Rekate HL, Klopfenstein JD, Sonntag VK: Treatment of basilar invagination associated with Chiari I malformations in the pediatric population: cervical reduction and posterior occipitocervical fusion. J Neurosurg. 2004, 101 (Suppl 2): 189-195.PubMed
6.
go back to reference Matsunaga S, Ijiri K, Koga H: Results of a longer than 10-year follow-up of patients with rheumatoid arthritis treated by occipitocervical fusion. Spine. 2000, 25: 1749-1753. 10.1097/00007632-200007150-00002.CrossRefPubMed Matsunaga S, Ijiri K, Koga H: Results of a longer than 10-year follow-up of patients with rheumatoid arthritis treated by occipitocervical fusion. Spine. 2000, 25: 1749-1753. 10.1097/00007632-200007150-00002.CrossRefPubMed
7.
go back to reference Matsunaga S, Sakou T, Onishi T, Hayashi K, Taketomi E, Sunahara N, Komiya S: Prognosis of patients with upper cervical lesions caused by rheumatoid arthritis: comparison of occipitocervical fusion between c1 laminectomy and nonsurgical management. Spine. 2003, 28: 1581-1587.PubMed Matsunaga S, Sakou T, Onishi T, Hayashi K, Taketomi E, Sunahara N, Komiya S: Prognosis of patients with upper cervical lesions caused by rheumatoid arthritis: comparison of occipitocervical fusion between c1 laminectomy and nonsurgical management. Spine. 2003, 28: 1581-1587.PubMed
8.
go back to reference Toyama Y, Matsumoto M, Chiba K, Asazuma T, Suzuki N, Fujimura Y, Hirabayashi K: Realignment of postoperative cervical kyphosis in children by vertebral remodeling. Spine. 1994, 19: 2565-2570. 10.1097/00007632-199411001-00012.CrossRefPubMed Toyama Y, Matsumoto M, Chiba K, Asazuma T, Suzuki N, Fujimura Y, Hirabayashi K: Realignment of postoperative cervical kyphosis in children by vertebral remodeling. Spine. 1994, 19: 2565-2570. 10.1097/00007632-199411001-00012.CrossRefPubMed
9.
go back to reference Matsunaga S, Onishi T, Sakou T: Significance of occipitoaxial angle in subaxial lesion after occipitocervical fusion. Spine. 2001, 26: 161-165. 10.1097/00007632-200101150-00010.CrossRefPubMed Matsunaga S, Onishi T, Sakou T: Significance of occipitoaxial angle in subaxial lesion after occipitocervical fusion. Spine. 2001, 26: 161-165. 10.1097/00007632-200101150-00010.CrossRefPubMed
10.
go back to reference Yoshida M, Neo M, Fujibayashi S, Nakamura T: Upper-airway obstruction after short posterior occipitocervical fusion in a flexed position. Spine. 2007, 32: 267-270. 10.1097/01.brs.0000259977.69726.6f.CrossRef Yoshida M, Neo M, Fujibayashi S, Nakamura T: Upper-airway obstruction after short posterior occipitocervical fusion in a flexed position. Spine. 2007, 32: 267-270. 10.1097/01.brs.0000259977.69726.6f.CrossRef
11.
go back to reference Phillips FM, Phillips CS, Wetzel FT, Gelinas C: Occipitocervical neutral position. Spine. 1999, 24: 775-778. 10.1097/00007632-199904150-00008.CrossRefPubMed Phillips FM, Phillips CS, Wetzel FT, Gelinas C: Occipitocervical neutral position. Spine. 1999, 24: 775-778. 10.1097/00007632-199904150-00008.CrossRefPubMed
12.
go back to reference Wholey MH, Bruwer AJ, Baker HL: The lateral roentgenogram of the neck; with comments on the atlanto-odontoid-basion relationship. Radiology. 1958, 71: 350-356. 10.1148/71.3.350.CrossRefPubMed Wholey MH, Bruwer AJ, Baker HL: The lateral roentgenogram of the neck; with comments on the atlanto-odontoid-basion relationship. Radiology. 1958, 71: 350-356. 10.1148/71.3.350.CrossRefPubMed
13.
go back to reference Harris JH, Carson GC, Wagner LK: Radiologic diagnosis of traumatic occipitovertebral dissociation: 1. Normal occipitovertebral relationships on lateral radiographs of supine subjects. Am J Roentgenol. 1994, 162: 881-886. 10.2214/ajr.162.4.8141012.CrossRef Harris JH, Carson GC, Wagner LK: Radiologic diagnosis of traumatic occipitovertebral dissociation: 1. Normal occipitovertebral relationships on lateral radiographs of supine subjects. Am J Roentgenol. 1994, 162: 881-886. 10.2214/ajr.162.4.8141012.CrossRef
14.
go back to reference Uno K, Kataoka O, Shiba R: Occipitoatlantal and occipitoaxial hypermobility in Down syndrome. Spine. 1996, 21: 1430-1434. 10.1097/00007632-199606150-00006.CrossRefPubMed Uno K, Kataoka O, Shiba R: Occipitoatlantal and occipitoaxial hypermobility in Down syndrome. Spine. 1996, 21: 1430-1434. 10.1097/00007632-199606150-00006.CrossRefPubMed
15.
go back to reference Wills BP, Auerbach JD, Glotzbecker MP, Drummond DS, Dormans JP: Change in lordosis at the occipitocervical junction following posterior occipitocervical fusion in skeletally immature children. Spine. 2006, 31: 2304-2309. 10.1097/01.brs.0000238974.90422.8d.CrossRefPubMed Wills BP, Auerbach JD, Glotzbecker MP, Drummond DS, Dormans JP: Change in lordosis at the occipitocervical junction following posterior occipitocervical fusion in skeletally immature children. Spine. 2006, 31: 2304-2309. 10.1097/01.brs.0000238974.90422.8d.CrossRefPubMed
Metadata
Title
Evaluation of occipitocervical neutral position using lateral radiographs
Authors
Jiangwei Tan
Guangjun Liao
Shaoxian Liu
Publication date
01-12-2014
Publisher
BioMed Central
Published in
Journal of Orthopaedic Surgery and Research / Issue 1/2014
Electronic ISSN: 1749-799X
DOI
https://doi.org/10.1186/s13018-014-0087-2

Other articles of this Issue 1/2014

Journal of Orthopaedic Surgery and Research 1/2014 Go to the issue