TY - JOUR
T1 - The influence of body posture on cervical alignment measured in the sagittal plane on conventional radiographs
T2 - A systematic review
AU - van Santbrink, Esther
AU - Schuermans, Valérie
AU - Goor, Ank van de
AU - de Bie, Rob
AU - Boselie, Toon
AU - van Santbrink, Henk
AU - Smeets, Anouk
PY - 2025/1/29
Y1 - 2025/1/29
N2 - BACKGROUND CONTEXT: Cervical sagittal balance parameters are an important aid in surgical decision-making and influence outcome in cervical spine surgery. In current literature, the normative values of these parameters vary highly within and between patients. This variability might be attributed to body posture. PURPOSE: The primary aim is to review the literature on the influence of body posture, including studies that compare sitting or standing positions possibly varying in arm positions, on cervical alignment measured in the sagittal plane on X-rays. STUDY DESIGN: A systematic review was performed. METHODS: PubMed, Embase, Cochrane Library, Web of Science, and CINAHL were systematically searched for articles published up to and including May 2024. The primary outcome was variability in cervical alignment in the sagittal plane as measured in altering body postures on X-rays. Quality of the included articles was assessed with the QUADAS-2 tool. RESULTS: Out of 17,628 screened articles, eight were eligible for inclusion. Articles were excluded based on irrelevant outcomes (n= 10,372), duplicates (n= 4,315), wrong study design (n= 1,462), or the influence of body posture was not described (n= 612). Overall cervical alignment ranged from 33.3 degrees lordosis to 3.5 degrees kyphosis. In all studies, statistically significant differences in T1 Slope (T1S), C2C7 Sagittal Vertical Axis (SVA), McGregor Slope (McGS), or C7 SVA were observed with respect to body posture. The observed differences between postures for cervical alignment ranged from 1 to 16.6 degrees. CONCLUSIONS: Body posture significantly influences cervical alignment values measured in the sagittal plane on X-rays. Studies investigating this influence are scarce and vary highly in investigated body postures. Standardization of body posture is imperative to enable optimal comparison of cervical sagittal balance parameters within and between patients, but also between studies. Moreover, the high variability observed raises questions about the comparability of measured values in previously published studies.
AB - BACKGROUND CONTEXT: Cervical sagittal balance parameters are an important aid in surgical decision-making and influence outcome in cervical spine surgery. In current literature, the normative values of these parameters vary highly within and between patients. This variability might be attributed to body posture. PURPOSE: The primary aim is to review the literature on the influence of body posture, including studies that compare sitting or standing positions possibly varying in arm positions, on cervical alignment measured in the sagittal plane on X-rays. STUDY DESIGN: A systematic review was performed. METHODS: PubMed, Embase, Cochrane Library, Web of Science, and CINAHL were systematically searched for articles published up to and including May 2024. The primary outcome was variability in cervical alignment in the sagittal plane as measured in altering body postures on X-rays. Quality of the included articles was assessed with the QUADAS-2 tool. RESULTS: Out of 17,628 screened articles, eight were eligible for inclusion. Articles were excluded based on irrelevant outcomes (n= 10,372), duplicates (n= 4,315), wrong study design (n= 1,462), or the influence of body posture was not described (n= 612). Overall cervical alignment ranged from 33.3 degrees lordosis to 3.5 degrees kyphosis. In all studies, statistically significant differences in T1 Slope (T1S), C2C7 Sagittal Vertical Axis (SVA), McGregor Slope (McGS), or C7 SVA were observed with respect to body posture. The observed differences between postures for cervical alignment ranged from 1 to 16.6 degrees. CONCLUSIONS: Body posture significantly influences cervical alignment values measured in the sagittal plane on X-rays. Studies investigating this influence are scarce and vary highly in investigated body postures. Standardization of body posture is imperative to enable optimal comparison of cervical sagittal balance parameters within and between patients, but also between studies. Moreover, the high variability observed raises questions about the comparability of measured values in previously published studies.
KW - C2-C7 Cobb angle
KW - Cervical spine
KW - X-ray
KW - body posture
KW - cervical alignment
KW - cervical sagittal balance parameters
KW - conventional radiograph
KW - position
U2 - 10.1016/j.spinee.2025.01.037
DO - 10.1016/j.spinee.2025.01.037
M3 - (Systematic) Review article
SN - 1878-1632
JO - The spine journal : official journal of the North American Spine Society
JF - The spine journal : official journal of the North American Spine Society
ER -