COMPARATIVE ANALYSIS OF CERVICAL SAGITTAL BALANCE WITH RADIOGRAPHS IN DIFFERENT POSTURES

ABSTRACT Objective: To compare the cervical sagittal balance in groups of patients submitted to lateral radiographs of the cervical segment, with the upper limbs in two different positions. Methods: This is a cross-sectional, quantitative, prospective, descriptive study using radiographic analysis of 100 adult individuals, aged between 20 and 70 years. Two lateral radiographs were taken of each patient, one image with the upper limbs crossed over the trunk (flexed elbows) and the other with the upper limbs elevated in front (extended elbows). All patients answered a questionnaire about age, sex, presence of pain in the cervical spine, as well as degree of pain based on the Likert scale. The radiographic parameters evaluated were the COBB angle (Cobb), thoracic inlet angle (TIA), T1 slope, neck tilt and distance from the center of gravity (COG) of the skull to C7 (COG-C7) with the elbows in extension (Ext) and flexion (Flex). A p-value of less than 0.05 was considered a statistically significant difference. Results: Sixty patients were female (60%) and forty were male (40%). The data analysis obtained showed statistical significance in Cobb Flex vs. Cobb Ext (p = 0.000), TIA Flex vs. TIA Ext (p = 0.000), T1 Flex vs. T1 Ext (p = 0.000), Neck tilt Flex vs. Neck tilt Ext (p = 0.000), and COG-C7 Flex vs. COG-C7 Ext (p = 0.000). Conclusion: There was statistical significance in relation to the positioning of the upper limbs in the lateral radiographs, yielding higher values in the angulations with the limbs raised towards the front (extended elbows). Level of evidence II; Prospective Comparative Study.

摘要
研究目的：对比两组接受颈椎节段侧位X线检查的受试者的颈椎矢状位平衡状态，两组受试者上肢采取两种不同体位。
方法：本研究为横断面、定量、前瞻性描述性研究，对100名年龄介于20至70岁的成年个体开展影像学分析。每位受试者拍摄两张颈椎侧位X线片：一张为上肢交叉置于躯干（肘部屈曲），另一张为上肢前伸抬高（肘部伸展）。所有受试者填写了涵盖年龄、性别、颈椎疼痛史以及基于李克特（Likert）量表的疼痛程度的调查问卷。本研究评估的影像学参数包括Cobb角（COBB）、胸廓入口角（thoracic inlet angle, TIA）、T1倾斜角、颈椎倾斜角以及颅骨重心（center of gravity, COG）至C7椎体的距离（COG-C7），分别在肘部伸展（Ext）和屈曲（Flex）状态下进行测量。本研究将p值小于0.05判定为存在统计学显著性差异。
结果：本研究共纳入60名女性受试者（占比60%），40名男性受试者（占比40%）。数据分析结果显示，屈曲组与伸展组的Cobb角（p=0.000）、胸廓入口角（p=0.000）、T1倾斜角（p=0.000）、颈椎倾斜角（p=0.000）以及COG-C7距离（p=0.000）均存在统计学显著性差异。
结论：颈椎侧位X线摄影中上肢体位对各项影像学参数存在统计学显著性影响，当前肢向前抬高（肘部伸展）时，各角度参数数值更高。
证据等级：II级；前瞻性对照研究。