RETROSPECTIVE STUDY OF RADIOLOGICAL ALIGNMENT IN CERVICAL MYELOPATHY

Introduction Cervical myelopathy is common and can lead to significant morbidities and can be caused by various pathologies. Understanding radiological differences between them would be crucial for optimising diagnosis and treatment. This study aims to outline the prevalence of cervical spine pathologies contributing to myelopathy and the correlation between cervical alignment and the causative pathology. Methods A retrospective analysis was conducted on patients referred to our spine centre from 2020–2024. The preoperative and postoperative imaging, patient demographics (age, ethnicity, BMI) and clinical presentation were reviewed. Pathologies identified were spondylosis, disc protrusion and Ossification of the Posterior Longitudinal Ligament (OPLL), and their alignments were assessed using erect X-ray and MRI using the C2–C7 Cobb angle. Results 42 patients were included in the study after exclusion. 85.7% of them had myelopathic signs and 38% of them had associated radicular symptoms. Spondylosis accounted for 59.5%, disc protrusion 23.8% and OPLL 16.6% of patients. The average C2 to C7 Cobb angle on erect X-ray for spondylosis was 4.3±14.1°, for disc it was 9.4±13.9°, and for OPLL 8.8±9.8°. On MRI these were 6.0±12.2°, 5.3±8.0° and 4.5±9.5° respectively. There was no statistically significant difference between the groups and no correlation between pathology and cobb angle was found (C2-7 cobb angle on erect X-ray r=-0.653; p=0.526, cobb angle on MRI r=0.069, p=0.934). Discussion Our study found no significant correlation between the specific cervical spine pathologies and the cervical spine alignments. There was a wide confidence interval within the pathology groups which could suggest individual variability in cervical alignment irrespective of the causative pathology. Despite these findings, the alignment remains a critical factor in cervical spine surgical planning. Conclusion No significant correlation was found between pathology and Cobb angle on X-ray or MRI. Erect X-ray remains crucial for accurate cervical alignment and optimal treatment planning.