Oblique Radiographs Compared Favorably With Computed Tomography Images in Assessing Cervical Foraminal Area

Oblique radiographs are often ordered to evaluate the patency of cervical intervertebral foramina. Previous studies have shown that computed tomography (CT) provides accurate measurements of foraminal dimensions. Up until now, no study has directly compared the diagnostic utility of oblique radiographs and CT.

We conducted a study to quantify the correlation between cervical foramina dimensions measured on oblique radiographs and on CT scans. Heights, widths, and cross-sectional areas were evaluated at every level from C2–C3 through C7–T1 using both oblique radiographs and oblique CT reconstructions. Both measurements were performed at a 50% oblique angle.

Interreliability and intrareliability statistics for radiographs and CT were 0.91 and 0.99 for height, 0.90 and 0.97 for width, and 0.84 and 0.92 for area. Pearson correlation coefficients for height, width, and area were 0.439, 0.871, and 0.899, respectively.

Oblique radiographs of the cervical spine provide accurate estimates of intervertebral foraminal dimensions—estimates similar to those generated from CT reconstructions. Thus, these radiographs may serve as an acceptable first-line imaging study for initial assessment of patients suspected of having nerve root compression that precludes the higher cost and radiation exposure associated with CT scans.