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
目的：对比上肢处于两种不同体位时，接受颈椎节段侧位X线摄片的患者群体的颈椎矢状位平衡情况。
方法：本研究为横断面、定量、前瞻性描述性研究，纳入100名年龄介于20~70岁的成年个体开展影像学分析。每位患者均拍摄两张颈椎侧位X线片：一张为上肢交叉于躯干（肘部屈曲）体位，另一张为上肢向前抬举（肘部伸展）体位。所有患者填写了涵盖年龄、性别、颈椎疼痛情况以及基于李克特（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、颈倾斜角，以及颅骨重心（center of gravity, COG）至C7椎体的距离（COG-C7），分别采集肘部伸展（Ext）与屈曲（Flex）状态下的对应数值。以P值<0.05为差异具有统计学意义的判定标准。
结果：本研究纳入的患者中60例为女性（占比60%），40例为男性（占比40%）。数据分析显示，屈曲位与伸展位的Cobb角（P=0.000）、TIA（P=0.000）、T1倾斜角（P=0.000）、颈倾斜角（P=0.000）以及COG-C7距离（P=0.000）的组间差异均具有统计学意义。
结论：上肢体位对颈椎侧位X线摄片的相关参数存在显著影响，上肢向前抬举（肘部伸展）体位下的各项角度参数数值更高。证据等级：Ⅱ级；前瞻性对照研究。