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Palpation and X-ray of the Upper Cervical Spine: A Reliability Study

John Hart, D.C.


Journal of Vertebral Subluxation Research ~ October 25, 2006 ~ Pages 1-14


Introduction: A complete examination of vertebral subluxation includes assessment of its neurological and misalignment components. A number of tests exist for determining alignment of vertebrae, and among these are palpation and x-ray. This study assesses the reliability of palpation and x-ray for determining vertebral alignment of the upper cervical spine.


Methods: Thirty one patients, who were already scheduled for clinically necessary x-rays, were palpated by two independent examiners immediately following their x-rays. The radiographs were subsequently analyzed by two other examiners. Thirty-four palpation assessments and 30 x-ray assessments were analyzed for reliability using the kappa statistical test and percent agreement.


Results: According to the kappa test, there were six x-ray assessments that had acceptable (.4 or greater) reliability. None of the palpation findings had acceptable reliability.


Conclusion: Knowing which assessments have been shown to have acceptable reliability can help the chiropractor apply proper weight to the individual assessments, particularly when the assessments disagree. Determining which tests are reliable and which ones are not is important in contributing to the establishment of an evidence base for determining vertebral listings. More research is needed to verify the findings in this study.


Key wordsX-ray, palpation, inter-examiner reliability

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