Value of the swimming position and arm traction in visualizing the cervicothoracic junction over the standard lateral cervical X-ray

Abstract

BackgroundThe cervicothoracic junction (CTJ) is often inadequately visualized on lateral cervical X-rays due to anatomic variations and technical factors.AimsThe aim of this study was to investigate whether the swimmer’s view and arm traction could enhance the image field on the standard lateral cervical (SLC) X-ray.MethodsThe study was conducted in a university hospital in October 2007 with 40 volunteers. SLC X-ray, lateral cervical X-ray in the swimming position, and lateral cervical X-ray with arm traction were performed in the supine position. The enhancements in the image fields were analyzed.ResultsThere was a statistically significant difference for the increases in the view of cervical spines between SLC X-ray (12.60 ± 7.48) and either lateral cervical X-ray with arm traction (21.73 ± 9.78; p = 0.000) or in the swimming position (21.20 ± 14.19; p = 0.001). Both arm traction and swimming position increased the field of view by approximately 9 mm. Increased visualization of the cervical spine occurred for 24 of the 40 participants using the arm traction view (60.0%) and 23 participants (57.5%) using the swimming position view—results found to be statistically similar according to the ≥ 1/3 caudal vertebral height visualized (p = 0.902). Using the lateral cervical X-ray view, the number of cervical vertebrae visualized differed according to body mass index (BMI)—seven cervical vertebrae were visualized in participants with a BMI < 25 and six vertebrae were visualized in participants with a BMI ≥ 25 (p = 0.007).ConclusionLateral cervical X-rays with arm traction and swimming position enhance the view of SLC X-rays. An initial SLC X-ray including the lower third of the cervical spine (with C7), arm traction, and swimming position may be beneficial in visualizing the CTJ. However, patients with an increased BMI are unlikely to benefit from all three methods.

Intra-operative upper limb manual traction to improve radiographic view of the distal cervical spine

“…2,3 Evidence exists for its efficacy; a study by Toksoy et al 4 showed a statistically significant improvement in cervical spine visualization by an average of 9 mm with the use of weight-assisted upper limb traction. 4 There is a lack of evidence in the literature, clearly describing the use of manual arm traction during spinal surgery to improve the view of the cervical spine.…”

A Long-Term Control Study of the Treatment of Cervical Radiculopathy by Percutaneous Endoscopic Posterior Cervical Discectomy and Anterior Cervical Decompression, Bone Graft Fusion and Internal Fixation

“…The NDI, neck and arm VAS score, X-ray, MRI and CT were evaluated on the day before surgery and 3 m, 6 m, 12 m, 24 m, 36 m, 48 m, 60 m and the last follow-up after surgery. The Cobb angle of cervical was measured by C2-7 lordosis (Figure .4B) [28], and DHI was measured by Emery [29]. According to the modi ed P rrmann classi cation, the degree of cervical disc degeneration was evaluated before and after operation [30].…”

A Long-Term Control Study of the Treatment of Cervical Radiculopathy by Percutaneous Endoscopic Posterior Cervical Discectomy and Anterior Cervical Decompression, Bone Graft Fusion and Internal Fixation

“…The NDI, neck and arm VAS score, X-ray, MRI and CT were evaluated on the day before surgery and 3 m, 6 m, 12 m, 24 m, 36 m, 48 m, 60 m and the last follow-up after surgery. The Cobb angle of cervical was measured by C2-7 lordosis ( Figure.4 B) [28], and DHI was measured by Emery [29]. According to the modi ed P rrmann classi cation, the degree of cervical disc degeneration was evaluated before and after operation [30].…”