The effect of cervical spine flexion-extension motion on odontoid parameters

Abstract Objective To assess the stability of odontoid parameters on flexion-extension motion and to validate the accuracy of the physiological cervical lordosis (CL) predictive formula across different cervical positions. Methods Standard cervical spine lateral radiographs in neutral, flexion, and...

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Main Authors: Longao Huang, Dun Liu, Hongyuan Xu, Junfei Feng, Tao Kang, Shengwang Wei, Hua Jiang
Format: Article
Language:English
Published: BMC 2025-01-01
Series:Journal of Orthopaedic Surgery and Research
Subjects:
Online Access:https://doi.org/10.1186/s13018-025-05488-7
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author Longao Huang
Dun Liu
Hongyuan Xu
Junfei Feng
Tao Kang
Shengwang Wei
Hua Jiang
author_facet Longao Huang
Dun Liu
Hongyuan Xu
Junfei Feng
Tao Kang
Shengwang Wei
Hua Jiang
author_sort Longao Huang
collection DOAJ
description Abstract Objective To assess the stability of odontoid parameters on flexion-extension motion and to validate the accuracy of the physiological cervical lordosis (CL) predictive formula across different cervical positions. Methods Standard cervical spine lateral radiographs in neutral, flexion, and extension positions were collected to measure odontoid incidence (OI), odontoid tilt (OT), C2 slope (C2S), CL, T1 slope (T1S), and T1S minus CL (T1S-CL). Friedman’s test was used to assess the differences in parameters among the three cervical spine positions. The predictive performance of the formula CL = 0.36× OI − 0.67 × OT − 0.69 × T1S was assessed and validated using the Pearson correlation coefficient (r), coefficient of determination (R²), mean squared error (MSE), and mean absolute error (MAE). Results No significant differences were found for OI and T1S among the three different cervical spine positions (p = 0.162 and p = 0.186, respectively). There was a strong, significant positive correlation between the predicted value and actual value of physiological CL at three cervical positions (neutral, flexion, and extension). The predictions for the neutral position were the most accurate, with statistical measures of r = 0.85 (p < 0.01), R²=0.82, MAE = 4.28, and MSE = 27.77. Conclusion OI is a stable and reliable anatomic parameter, not affected by cervical spine flexion-extension motion. OI can serve as a supplementary parameter for evaluating cervical sagittal balance and compensatory ability. The formula CL = 0.36×OI − 0.67×OT − 0.69×T1S provides the best predictions for physiological CL in the neutral position.
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spelling doaj-art-1f3bb839344840688fa805dc0ce2d4d02025-01-19T12:32:44ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2025-01-0120111010.1186/s13018-025-05488-7The effect of cervical spine flexion-extension motion on odontoid parametersLongao Huang0Dun Liu1Hongyuan Xu2Junfei Feng3Tao Kang4Shengwang Wei5Hua Jiang6Department of Spine Surgery, The First Affiliated Hospital of Guangxi Medical UniversityDepartment of Spine Surgery, The First Affiliated Hospital of Guangxi Medical UniversityDepartment of Spine Surgery, The First Affiliated Hospital of Guangxi Medical UniversityDepartment of Spine Surgery, The First Affiliated Hospital of Guangxi Medical UniversityDepartment of Spine Surgery, The First Affiliated Hospital of Guangxi Medical UniversityDepartment of Orthopedics, The Fourth Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous RegionDepartment of Spine Surgery, The First Affiliated Hospital of Guangxi Medical UniversityAbstract Objective To assess the stability of odontoid parameters on flexion-extension motion and to validate the accuracy of the physiological cervical lordosis (CL) predictive formula across different cervical positions. Methods Standard cervical spine lateral radiographs in neutral, flexion, and extension positions were collected to measure odontoid incidence (OI), odontoid tilt (OT), C2 slope (C2S), CL, T1 slope (T1S), and T1S minus CL (T1S-CL). Friedman’s test was used to assess the differences in parameters among the three cervical spine positions. The predictive performance of the formula CL = 0.36× OI − 0.67 × OT − 0.69 × T1S was assessed and validated using the Pearson correlation coefficient (r), coefficient of determination (R²), mean squared error (MSE), and mean absolute error (MAE). Results No significant differences were found for OI and T1S among the three different cervical spine positions (p = 0.162 and p = 0.186, respectively). There was a strong, significant positive correlation between the predicted value and actual value of physiological CL at three cervical positions (neutral, flexion, and extension). The predictions for the neutral position were the most accurate, with statistical measures of r = 0.85 (p < 0.01), R²=0.82, MAE = 4.28, and MSE = 27.77. Conclusion OI is a stable and reliable anatomic parameter, not affected by cervical spine flexion-extension motion. OI can serve as a supplementary parameter for evaluating cervical sagittal balance and compensatory ability. The formula CL = 0.36×OI − 0.67×OT − 0.69×T1S provides the best predictions for physiological CL in the neutral position.https://doi.org/10.1186/s13018-025-05488-7Cervical flexion and extensionCervical spine motionCL predictionOdontoid incidence
spellingShingle Longao Huang
Dun Liu
Hongyuan Xu
Junfei Feng
Tao Kang
Shengwang Wei
Hua Jiang
The effect of cervical spine flexion-extension motion on odontoid parameters
Journal of Orthopaedic Surgery and Research
Cervical flexion and extension
Cervical spine motion
CL prediction
Odontoid incidence
title The effect of cervical spine flexion-extension motion on odontoid parameters
title_full The effect of cervical spine flexion-extension motion on odontoid parameters
title_fullStr The effect of cervical spine flexion-extension motion on odontoid parameters
title_full_unstemmed The effect of cervical spine flexion-extension motion on odontoid parameters
title_short The effect of cervical spine flexion-extension motion on odontoid parameters
title_sort effect of cervical spine flexion extension motion on odontoid parameters
topic Cervical flexion and extension
Cervical spine motion
CL prediction
Odontoid incidence
url https://doi.org/10.1186/s13018-025-05488-7
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