Magnetic resonance imaging: A possible alternative to a standing lateral radiograph for evaluating cervical sagittal alignment in patients with cervical disc herniation?

Background and Objectives: Convincing evidence supporting the use of magnetic resonance imaging (MRI) as an effective tool for evaluating cervical sagittal alignment is lacking. This study aims to analyze the differences and correlations between cervical sagittal parameters on x-ray and MRI in patients with cervical disc herniation and to determine whether MRI could substitute for cervical x-ray for measurement of cervical sagittal parameters.

Methods: One hundred forty-three adults with cervical disc herniation were recruited. Each patient had both an x-ray and MRI examination of the cervical spine. The cervical sagittal parameters were measured and compared on x-ray and MRI including: C2-C7 Cobb angle, C2-C7 sagittal vertical axis (C2-C7 SVA), cervical tilt (CT), T1 Slope (T1S), and neck tilt (NT). The data were analyzed using a paired-samples t test, a Pearson correlation test, and linear regression.

Results: The values of C2-C7 Cobb angle, C2-C7 SVA, CT and T1S on X-ray were larger than those on MRI (P < .05) and NT on X-ray was smaller than that on MRI (P < .05). Each of the cervical sagittal parameters had a significant correlation with the corresponding one on MRI (r = 0.699, 0.585, 0.574, 0.579 and 0.613, respectively) (C2-C7 Cobb MRI = 0.957 + 0.721 C2-C7 Cobb X, C2-C7 SVA MRI = 6.423 + 0.500 C2-C7 SVAX, CT MRI = 3.121 + 0.718 CTX, T1S MRI = 7.416 + 0.613 T1SX, NT MRI = 22.548 + 0.601 NTX).

Conclusion: Although MRI and x-ray measurements of cervical sagittal parameters were different, there were significant correlations between the results. MRI could be used to evaluate the sagittal balance of the cervical spine with great reliability.