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European Spine Journal

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01-10-2019 | Original Article

The most appropriate cervical vertebra for the measurement of occipitocervical inclination parameter: a validation study of C3, C4, and C5 levels using multi-positional magnetic resonance imaging

Authors: Permsak Paholpak, Blake Formanek, Andrew Vega, Koji Tamai, Zorica Buser, Jeffrey C. Wang

Published in: European Spine Journal | Issue 10/2019

Abstract

Purpose

To evaluate which cervical level is the most appropriate level to measure occipitocervical inclination (OCI).

Methods

Sixty-two patients with multi-positional MRI: 24 males and 38 females, who had cervical lordosis and had a disk degeneration grade of 3 or less were included. We measured patient’s OCI at C3, C4, and C5, occipitocervical angle (OCA), occipitocervical distance (OCD), C2–7 angle, and cervical sagittal vertical axis (cSVA) in neutral, flexion, and extension position. The correlation between OCI and OCA, OCD, C2–7 angle, and cSVA on each cervical level in all three positions was tested using Pearson’s correlation coefficient test. The difference between OCIs at each cervical level was tested by Wilcoxon signed-rank test. p value of less than 0.05 was set as a statistically significant level.

Results

C5 OCI showed statistically significant correlation with OCA, OCD, C2–7 angle, and cSVA in all three positions (p < 0.05, r = 0.214–0.525). C3 OCI in flexion (p = 0.393, r = 0.081) and C4 OCI in neutral and flexion (neutral p = 0.275, r 0.104; flexion p = 0.987, r = 0.002) did not show significant correlation with C2–7 angle. There was a statistically significant difference between C3, C4, and C5 OCIs in neutral and extension position (p < 0.05). At the same time, OCI showed statistically strong correlation between adjacent cervical levels (p < 0.001, r = 0.627–0.822).

Conclusion

C5 cervical level is the most appropriate level for OCI measurement. OCI should be measured at the same cervical level at all time. C4 OCI can reliably substitute C5 OCI in case C5 which is invisible on radiographic image.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

Available only for authorised users

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Title: The most appropriate cervical vertebra for the measurement of occipitocervical inclination parameter: a validation study of C3, C4, and C5 levels using multi-positional magnetic resonance imaging
Authors: Permsak Paholpak
Blake Formanek
Andrew Vega
Koji Tamai
Zorica Buser
Jeffrey C. Wang
Publication date: 01-10-2019
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 10/2019
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-019-06028-8

At a glance: The STEP trials

Springer Medicine

The most appropriate cervical vertebra for the measurement of occipitocervical inclination parameter: a validation study of C3, C4, and C5 levels using multi-positional magnetic resonance imaging

Abstract

Purpose

Methods

Results

Conclusion

Graphical abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Graphical abstract

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