Cervical Lordosis: Imaging Position and Measurement

NCT07541586 | Active Not Recruiting

• 1 other identifier: CLIP-M-001
• Study Type: observational
• Target: 58
• Locations: 1 country
• Sites: 1

Brief Summary

This retrospective cross-sectional study aims to compare cervical lordosis measurements obtained from standing lateral radiographs and supine magnetic resonance imaging (MRI) in individuals without structural cervical pathology. The study also evaluates the independent contribution of T1 slope to cervical alignment and investigates whether imaging modality significantly alters measured lordosis values.

Conditions

Lordosis; Postural; Radiographic Study; Radiographic Outcomes; Magnetic Resonance Imaging (MRI); Supine Position; Cervical Lordosis

Keywords

Cervical lordosis; Magnetic resonance imaging; Radiography; Position; Cobb angle; T1 slope; Standing radiograph; Supine MRI; Cervical sagittal alignment

Outcome Measures

Primary Outcomes (2)

• Difference in Cobb C2-C7 angle between standing radiographs and supine MRI

  Cobb C2-C7 angle measured using standard endplate-based methodology on standing lateral cervical radiographs and supine cervical MRI. The primary comparison evaluates the difference in cervical lordosis between imaging modalities obtained under weight-bearing and non-weight-bearing conditions.

  Baseline retrospective image assessment

• Difference in Cobb C1-C7 angle between standing radiographs and supine MRI

  Cobb C1-C7 angle measured on standing lateral radiographs and supine MRI using standard radiographic techniques. This outcome assesses global cervical lordosis differences between imaging modalities.

  Baseline retrospective image assessment

Secondary Outcomes (6)

• Association between T1 slope and Cobb C2-C7 angle

  Baseline retrospective image assessment

• Association between T1 slope and Cobb C1-C7 angle

  Baseline retrospective image assessment

• Multivariable linear regression model for Cobb C2-C7

  Baseline retrospective image assessment

• Multivariable linear regression model for Cobb C1-C7

  Baseline retrospective image assessment

• Effect of sex on cervical sagittal alignment

  Baseline retrospective image assessment

Other Outcomes (3)

• Difference in posterior tangent C2-C7 angle between standing radiographs and supine MRI

  Baseline retrospective image assessment

• Association between T1 slope and posterior tangent C2-C7 angle

  Baseline retrospective image assessment

• Multivariable linear regression model for posterior tangent C2-C7

  Baseline retrospective image assessment

Study Arms (2)

Standing Radiograph Group

Individuals with standard lateral cervical radiographs obtained in the upright neutral standing position.

Other: No intervention

Supine MRI Group

Individuals with standard cervical magnetic resonance imaging obtained in the supine position.

Other: No intervention

Interventions

No intervention OTHER

This is an observational study with no assigned intervention. Groups are defined based on the imaging modality (standing radiograph vs supine MRI).

Standing Radiograph Group; Supine MRI Group

Eligibility Criteria

• Age: 18 Years - 65 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Adults aged 18-65 years with clinically obtained standing cervical radiographs or supine cervical MRI during the registry period and without structural cervical pathology affecting alignment.

You may qualify if:

• Adults aged 18 to 65 years
• Availability of standing lateral cervical radiograph or supine cervical MRI performed during the registry period
• No structural cervical pathology affecting sagittal alignment
• Images of adequate quality for radiographic measurement
• Neutral standing radiograph position for Standing Radiograph Group
• Standard supine acquisition for Supine MRI Group

You may not qualify if:

• Prior cervical spine surgery
• Cervical fracture, dislocation, or whiplash history
• Primary or metastatic cervical malignancy
• Congenital vertebral anomaly including Klippel-Feil syndrome, os odontoideum, hemivertebra, block vertebra, or atlantoaxial instability
• Spinal deformity or postural disorder likely to affect cervical alignment, including scoliosis, hyperkyphosis, or Scheuermann disease
• Advanced degenerative cervical disease, including severe spondylosis, cervical spinal stenosis, OPLL, or DISH
• Inflammatory or autoimmune rheumatologic disease affecting the spine
• Neuromuscular or neurologic disorders affecting posture or alignment
• Inadequate image quality, major artifact, or improper positioning

Sponsors & Collaborators

• Medipol University: lead

Study Sites (1)

İstanbul Medipol University

Istanbul, Turkey (Türkiye)

Location

Related Publications (10)

• Sevin, I.E.; Bozdag, S.; Erisken, E.; Sucu, H.K. Comparison of Radiography with Computed Tomography and Magnetic Resonance Imaging in the Measurement of Cervical Lordosis. Medicina 2025, 61, 1654. https://doi.org/10.3390/medicina61091654

  BACKGROUND

• Weinberg DS, Chugh AJ, Gebhart JJ, Eubanks JD. Magnetic Resonance Imaging of the Cervical Spine Under-Represents Sagittal Plane Deformity in Degenerative Myelopathy Patients. Int J Spine Surg. 2016 Sep 7;10:32. doi: 10.14444/3032. eCollection 2016.

  PMID: 27909653 BACKGROUND

• Boudreau C, Carrondo Cottin S, Ruel-Laliberte J, Mercier D, Gelinas-Phaneuf N, Paquet J. Correlation of supine MRI and standing radiographs for cervical sagittal balance in myelopathy patients: a cross-sectional study. Eur Spine J. 2021 Jun;30(6):1521-1528. doi: 10.1007/s00586-021-06833-0. Epub 2021 Apr 21.

  PMID: 33881642 BACKGROUND

• Park JH, Cho CB, Song JH, Kim SW, Ha Y, Oh JK. T1 Slope and Cervical Sagittal Alignment on Cervical CT Radiographs of Asymptomatic Persons. J Korean Neurosurg Soc. 2013 Jun;53(6):356-9. doi: 10.3340/jkns.2013.53.6.356. Epub 2013 Jun 30.

  PMID: 24003370 BACKGROUND

• Staub BN, Lafage R, Kim HJ, Shaffrey CI, Mundis GM, Hostin R, Burton D, Lenke L, Gupta MC, Ames C, Klineberg E, Bess S, Schwab F, Lafage V; International Spine Study Group. Cervical mismatch: the normative value of T1 slope minus cervical lordosis and its ability to predict ideal cervical lordosis. J Neurosurg Spine. 2018 Oct 5;30(1):31-37. doi: 10.3171/2018.5.SPINE171232. Print 2019 Jan 1.

  PMID: 30485176 BACKGROUND

• Janusz P, Tyrakowski M, Yu H, Siemionow K. Reliability of cervical lordosis measurement techniques on long-cassette radiographs. Eur Spine J. 2016 Nov;25(11):3596-3601. doi: 10.1007/s00586-015-4345-8. Epub 2015 Dec 26.

  PMID: 26707132 BACKGROUND

• Martini ML, Neifert SN, Chapman EK, Mroz TE, Rasouli JJ. Cervical Spine Alignment in the Sagittal Axis: A Review of the Best Validated Measures in Clinical Practice. Global Spine J. 2021 Oct;11(8):1307-1312. doi: 10.1177/2192568220972076. Epub 2020 Nov 18.

  PMID: 33203239 BACKGROUND

• Harrison DE, Harrison DD, Cailliet R, Troyanovich SJ, Janik TJ, Holland B. Cobb method or Harrison posterior tangent method: which to choose for lateral cervical radiographic analysis. Spine (Phila Pa 1976). 2000 Aug 15;25(16):2072-8. doi: 10.1097/00007632-200008150-00011.

  PMID: 10954638 BACKGROUND

• Ames CP, Blondel B, Scheer JK, Schwab FJ, Le Huec JC, Massicotte EM, Patel AA, Traynelis VC, Kim HJ, Shaffrey CI, Smith JS, Lafage V. Cervical radiographical alignment: comprehensive assessment techniques and potential importance in cervical myelopathy. Spine (Phila Pa 1976). 2013 Oct 15;38(22 Suppl 1):S149-60. doi: 10.1097/BRS.0b013e3182a7f449.

  PMID: 24113358 BACKGROUND

• Scheer JK, Tang JA, Smith JS, Acosta FL Jr, Protopsaltis TS, Blondel B, Bess S, Shaffrey CI, Deviren V, Lafage V, Schwab F, Ames CP; International Spine Study Group. Cervical spine alignment, sagittal deformity, and clinical implications: a review. J Neurosurg Spine. 2013 Aug;19(2):141-59. doi: 10.3171/2013.4.SPINE12838. Epub 2013 Jun 14.

  PMID: 23768023 BACKGROUND

MeSH Terms

Conditions

Lordosis; Deception

Condition Hierarchy (Ancestors)

Spinal Curvatures; Spinal Diseases; Bone Diseases; Musculoskeletal Diseases; Social Behavior; Behavior

Study Design

• Study Type: observational
• Observational Model: OTHER
• Time Perspective: RETROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Study Record Dates

• First Submitted: April 14, 2026
• First Posted: April 21, 2026
• Study Start: January 1, 2025
• Primary Completion: January 1, 2026
• Study Completion (Estimated): June 1, 2026
• Last Updated: May 6, 2026

Record last verified: 2026-04

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)