Catherine Boudreau, Sylvine Carrondo Cottin, Jessica Ruel-Laliberté, David Mercier, Nicholas Gélinas-Phaneuf, Jérôme Paquet

June 2021, Volume 30, Issue 6, pp 1521 - 1528 Original Article Read Full Article 10.1007/s00586-021-06833-0

First Online: 21 April 2021


Cervical sagittal alignment is correlated with myelopathy severity and used by spinal surgeons for surgical planification. Magnetic resonance imaging (MRI) is the gold standard for the evaluation of cervical myelopathy but may not be for the assessment of cervical sagittal balance compared to X-rays. The objective of this study was to assess the correlation of cervical alignment between supine MRI and standing radiographs in patients with cervical spondylotic myelopathy (CSM).


Cobb, Jackson and Harrison methods were used to measure cervical sagittal alignment on supine MRI and standing radiographs of CSM adults. Cervical alignment was divided based on Cobb angle values on lordotic (> 4°), kyphotic (< − 4°) and rectitude (− 4° to 4°). Correlations between radiographic and MRI measurements were determined. Intra- and interobserver reliability were assessed and MRI and X-Ray-measured angles were compared.


One hundred and thirty patients with CSM were reviewed. Correlations of cervical lordosis measures between radiographs and MRI were strong using the Cobb (0.65) and Jackson (0.63) methods, and moderate using the Harrison (0.37) method. Mean cervical lordosis angle was significantly lower on supine MRI compared to standing radiographs for all methods (Cobb 11.6 Rx vs. 9.2 MRI, Jackson 14.6 vs. 11.6, Harrison 23.5 vs. 19.9). Eighteen patients (15.4%) without lordosis on supine MRI presented lordosis on standing radiographs.


A substantial proportion of patients has sagittal alignment discrepancies between supine MRI and standing radiographs. Therefore, standing radiographs of the cervical spine should always be included in surgical planning of CSM patients.

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