Evidence map›Paper›PMID 32450918›Full record

ArticleChiropractic & manual therapies2020

Inter-examiner reliability of radiographic measurements from Open-mouth lateral bending cervical radiographs.

Karthik V Hariharan, Lauren Terhorst, Matthew D Maxwell, Christopher G Bise, Michael G Timko, Michael J Schneider

Open access · goldAbstract read
In one paragraph

Article in Chiropractic & manual therapies, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
0.6field-weighted citation impact, top 32% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it, 8 citations in OpenAlex.

  1. Computed tomography versus magnetic resonance imaging of the cervical spine in the spinal clearance of trauma patients: a systematic review and meta-analyses.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2025
    Pooled it
  2. Review
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 3 institutions in 1 country.

Karthik V HariharanDepartment of Physical Therapy, University of Pittsburgh, 6046 A Forbes Tower, Pittsburgh, PA, 15260, USA. kvh4@pitt.edu.ORCID 0000-0002-2827-4869
Lauren TerhorstDepartment of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA, USA.
Matthew D MaxwellInterventional Spine and Sports Medicine, MedStar National Rehabilitation Network, School of Medicine, Georgetown University, Washington, DC, USA.
Christopher G BiseDepartment of Physical Therapy, University of Pittsburgh, 6046 A Forbes Tower, Pittsburgh, PA, 15260, USA.
Michael G TimkoDepartment of Physical Therapy, University of Pittsburgh, 6046 A Forbes Tower, Pittsburgh, PA, 15260, USA.
Michael J SchneiderDepartment of Physical Therapy, University of Pittsburgh, 6046 A Forbes Tower, Pittsburgh, PA, 15260, USA.
University of Pittsburgh · USMedStar National Rehabilitation Hospital · USWest Virginia University · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundFollowing head and neck trauma, the involvement of the cranio-cervical junction (CCJ) and its contribution to a patients transition to chronic pain, is poorly understood. The detection of hypermobility in this region is dependent on clinical examination and static imaging modalities such as x-ray, CT and MRI. Sagittal plane hypermobility of the CCJ is evaluated using saggital view, flexion-extension cervical radiographs. Frontal plane hypermobility is typically assessed using lateral bending and open mouth cervical radiographs. Unfortunately there is no established reliability surrounding the use of these measures. This study explores the reliability of radiographic measurements of lateral-bending open-mouth cervical radiographs.

methodsCervical open-mouth lateral-bending X-ray images were collected from 56 different patients between 18 and 60 years of age patients following cervical spine injury. These images were interpreted by two musculoskeletal radiologists and two clinicians (physiatrist and chiropractor), using a standard set of measurements. Measurements included qualitative and quantitative assessments of the amount of asymmetry noted between various osseous landmarks. Reliability statistics were calculated for levels of agreement using kappa coefficients (κ) and Intraclass Correlation Coefficients (ICC) for dichotomous and continuous variables, respectively.

resultsReliability (κ) for qualitative assessments were moderate to substantial for asymmetry of neutral C2 spinous position, dens-lateral mass spacing, and "step off" between the lateral borders of the articular pillars of C2 and C1 lateral mass (κ range = .47-.78). ICC values for the quantitative measurements of dens-lateral mass spacing and "step off" between the lateral borders of the C2 articular pillars and C1 lateral mass were moderate to excellent (ICC range = .56-.97).

conclusionsThe qualitative and quantitative measurements used in this study demonstrated good to excellent inter-examiner reliability. Correlation with clinical findings is necessary to establish the utility of these measurements in clinical practice.

Indexed as

AdolescentAdultCervical VertebraeHumansMiddle AgedPatient PositioningRadiographyReproducibility of ResultsRetrospective StudiesYoung AdultCervical spine injuryCraniocervical junctionHypermobilityInstabilityRadiography

Identifiers

PMID32450918
PMCPMC7249371
OpenAlexW3032767047

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.