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The Reliability of Visual X-ray Analysis of the Cervical Spine and Pelvis: A Preliminary Study

Rodney Slusher, DC, Brad Shook, DC, Jeremy Hozjan, DC, Mark McCauley, DC, John Hart, DC, MHSc 

Journal of Vertebral Subluxation Research ~ March 25, 2010 ~ Pages 1-7



Introduction: Analysis for vertebral subluxation consists of assessment for a neurological and misalignment component. Chiropractors commonly perform visual and line analysis as part of the misalignment assessment. This study assesses the reliability of radiographic visual analysis for determining vertebral alignment of selected upper spine and lower spine segments.


Methods: Four radiograph, A-P and lateral cervical and A-P and lateral lumbopelvic radiographs of ten patients already under chiropractic care were selected for visual analysis. The cervical radiographs were analyzed for alignment of C1, C5, C7, while the lumbopelvic radiographs were analyzed for alignment of the sacrum, and ilium. Four examiners, utilizing both the Palmer and Gonstead systems of analysis, visually evaluated the 10 sets of cervical and lumbopelvic radiographs. The various directions of misalignment were assessed and examiner agreement was calculated using the Kappa statistic.


Results: Acceptable mean Kappa scores were found for C1 tilt on the lateral cervical radiographs , sacrum (PR, Pl; PIR/PIL) and ilium (AS/PI and IN/EX) . The weakest mean Kappa score was observed for C5 superiority / inferiority.


Conclusion: In this preliminary study, assessments for C1 tilt and sacrum listings showed acceptable mean Kappa scores. Future research should include a larger sample size to either verify or refute these findings. The reliability of different components of visual x-ray assessment can aid the chiropractor in deciding which misalignment criteria merit the highest level of consideration


Key Words: x-ray, visual analysis, radiograph, subluxation, Palmer, Gonstead.

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