Evidence map›Paper›PMID 42435062›Full record

ArticlePediatric radiology2026

Correlation of examiner judgement and radiological digital pictures in infants with upper cervical spine dysfunction: a cross-sectional study.

Jan Peter, Miklos Csato, Inga Paravicini, Martina Wehrli, Petra Schweinhardt, Anke Langenfeld

Registry-linked trialAbstract read
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In one paragraph

Article in Pediatric radiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04981782 (Passive Cervical Range of Motion in Infants With and Without Torticollis, Before, During and After Chiropractic Treatment), which is not on this map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

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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.

NCT04981782 completednot on this map

Passive Cervical Range of Motion in Infants With and Without Torticollis, Before, During and After Chiropractic Treatment

TypeobservationalSponsorBalgrist University HospitalRan2021 to 2024Enrolled74ConditionsArthrogenic TorticollisArmsNo study specific intervention, regular care.
3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

6 authors.

Jan PeterDepartment of Chiropractic Medicine, Balgrist University Hospital and University of Zurich, Zurich, Switzerland.
Miklos CsatoDepartment of Radiology, Balgrist University Hospital and University of Zurich, Zurich, Switzerland.
Inga ParaviciniDepartment of Chiropractic Medicine, Balgrist University Hospital and University of Zurich, Zurich, Switzerland.
Martina WehrliDepartment of Chiropractic Medicine, Balgrist University Hospital and University of Zurich, Zurich, Switzerland.
Petra SchweinhardtDepartment of Chiropractic Medicine, Balgrist University Hospital and University of Zurich, Zurich, Switzerland.
Anke LangenfeldDepartment of Chiropractic Medicine, Balgrist University Hospital and University of Zurich, Zurich, Switzerland. anke.langenfeld@balgrist.ch.ORCID https://orcid.org/0000-0001-7570-4289

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThis study aimed to (1) assess the inter-rater reliability of lateral atlantodental distance measurements in digital open-mouth radiographs of infants with upper cervical spine dysfunction, and (2) investigate correlations between lateral atlantodental distance values and clinical findings.

methods72 digital radiographs of the odontoid region from infants aged 3-12 months were analyzed (Aug 2021-Dec 2023). Lateral atlantodental distance was measured bilaterally by three independent raters. Inter-rater reliability and measurement precision was assessed using intraclass correlation coefficients (ICC), standard error of measurement (SEM), and minimal detectable change (MDC). Side differences were evaluated using paired t-tests. Mean lateral atlantodental distance values were further examined for their association with the clinically assessed side of cervical rotational malposition using logistic regression and receiver operating characteristic (ROC) analysis.

resultsInter-rater reliability was excellent for right (ICC=0.91 [95% CI: 0.86 - 0.94]) and left (ICC=0.91 [95% CI: 0.86 - 0.95]). The SEM was 0.62 mm for both sides, the MDC was 1.72 mm (right) and 1.73 mm (left). In infants with left-sided cervical rotational malposition, lateral atlantodental distance was significantly greater on the left side, whereas in infants with right-sided cervical rotational malposition, lateral atlantodental distance was significantly greater on the right side. Right-sided lateral atlantodental distance was a significant predictor of clinically assessed right-sided cervical rotational malposition (OR 1.80, 95% CI 1.14-2.84, P=0.01). ROC analysis demonstrated moderate discriminatory performance (AUC = 0.74), meaning that the model is reasonably capable of distinguishing patients with right-sided cervical rotational malposition from those without.

conclusionsAlthough lateral atlantodental distance measurements showed excellent inter-rater reliability, the SEM was relatively large compared with the small absolute values of the measurements (in millimeters), which limits the ability to detect subtle side-to-side asymmetries. Lateral atlantodental distance should be interpreted as a reproducible radiographic finding associated with cervical rotational malposition rather than as an independent diagnostic marker or pathognomonic sign in infants.

trial registrationClinicalTrials.gov ID NCT04981782 (28.07.2021).

Indexed as

ImagingInfantsOpen mouth odontoid viewUpper cervical spine dysfunction

Identifiers

PMID42435062

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