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Paul Oakley
Leesa Sanchez
Deed Harrison


Cervical Spine, Lordosis, MedicaL Imaging, Forward Head Posture


Objective: To compare medical radiologists’ subjective qualitative commentary on cervical spine alignment to the images’ actual quantitative and objective mensuration.

Methods: One-hundred-and-eight consecutive lateral cervical x-ray radiology reports were reviewed for commentary about cervical alignment. The radiographs were digitized and quantified into theoretical categories and compared to the commentary.

Results: Of the 100 images included for evaluation, 55 images had comments pertaining to ‘normal,’ 20 had ‘no comment,’ and 25 reports mentioned some sort of ‘abnormal’ alignment. Excessively hypolordotic/kyphotic necks were typically labeled as normal. Forward head posture and intersegmental kyphosis were frequently found in this patient sample but were never mentioned in a report even when in the severe range.

Conclusion: Medical radiologists in this study made generalized, non-specific comments regarding cervical lordosis, if mentioned at all. This suggests that they may not perceive the importance of cervical spine alignment as being involved in a patient’s complaint even when evidence suggests that cervical spine sagittal alignment is implicated in neck and headache symptomatology, physiological function, neurophysiological outcomes, and degenerative changes. This situation may fuel existing barriers between differing healthcare professionals as to how much emphasis should be placed on spinal alignment in the etiology of a patient’s cranio-cervical complaints.


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