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PubMed1994

Shortcomings of chest radiography in detecting Pneumocystis carinii pneumonia.

The radiographic presentation of Pneumocystis carinii pneumonia (PCP) was studied in 93 consecutive patients to determine the frequency of normal findings on chest roentgenograms and possible correlations with clinical or laboratory findings. The roentgenograms were reviewed by two radiologists in an independent, blinded way and judged with a score distinguishing between none, interstitial, and acinar infiltrates. Discordance mainly between absent versus interstitial and interstitial versus acinar infiltrates occurred in 23% of roentgenograms and was settled by consensus. The majority of patients presented with moderate-to-mild symptoms; the combination of dyspnea, cough, and fever was present in 53%. Lactate dehydrogenase (LDH) was elevated in 63%, hypoxemia (PaO2 < 75 mm Hg) was present in 57%. Findings on chest roentgenograms were normal in 39%, whereas 36% showed interstitial and 25% acinar infiltrates. These three radiographic groups represented an increasingly severe PCP, indicated by higher LDH levels and hypoxemia (both p < 0.05). In a multivariate logistic regression, normal roentgenograms were predicted by low LDH and low peripheral blood granulocytes (p < 0.005). Mortality within 3 weeks was only 4% and correlated with the severity of infiltrates (p < 0.05). Normal roentgenograms thus corresponded to an oligosymptomatic, less severe PCP. In immunodeficient HIV-infected patients, a normal chest roentgenogram does not exclude PCP and should not distract from attaining a definite diagnosis by examination of induced sputum or bronchoalveolar lavage.

Adult↗
PubMed2003

Anterior cruciate ligament tunnel placement: Comparison of insertion site anatomy with the guidelines of a computer-assisted surgical system.

PURPOSE: With the development of computer-assisted surgery (CAS) systems, the surgeon's ability to operate a CAS planning station will become essential. For example, default parameters in computed tomographic (CT) data are being used to place tunnels in anterior cruciate ligament (ACL) reconstruction. The goal of this study was to compare the location of the insertion sites in ACL reconstruction anatomically, via roentgenographic images and via CT scan data and to validate these tunnel placement parameters. TYPE OF STUDY: Cadaveric analysis. METHODS: Eight human cadaveric knees were marked with 6 copper wires 1 mm in diameter around the circumference of the insertions of the ACL. Using lateral roentgenograms and CT scans that were subsequently transferred to the CAS planning station, the tunnel locations were determined. These were based on a distance from the back of the condyle (location A) and from the roof of the notch (location B) on the femur and on a distance posterior from the tuberosity to the posterior margin along the tibial plateau, which is set as the CAS planning station's default. Locations according to roentgenograms and CT scans were then compared and the accuracy of the CAS planning station was assessed. RESULTS: Comparison of roentgenograms and CT revealed a femoral insertion at 27.5% +/- 3.2% and 26.9% +/- 3.5% (roentgenograms) and 26.6% +/- 1.9% and 26.3% +/- 2.4% (CT), respectively. The CAS planning station provided a tunnel location that was 1.3 +/- 1.0 mm (0.3 to 2.5 mm) away from the actual femoral ACL insertion. The tibial tunnel was placed according to the copper wire markers and was found to be at 46.2% +/- 2.8% (roentgenograms) and 45.4% +/- 2.1% (CT). No statistical differences between position in CT and roentgenograms could be detected (P >.05). CONCLUSIONS: The compared methodologies showed similar locations of the ACL insertions, assuring accurate preoperative planning with the CAS system. However, the CAS system requires adjustment to each individual knee anatomy.

Aged↗
PubMed1995

Decision rules for roentgenography of children with acute ankle injuries.

OBJECTIVE: The Ottawa Ankle Rules (OAR) assist emergency physicians in the appropriate use of roentgenography in adults with acute ankle injuries. The OAR state that ankle roentgenograms are needed only if there is pain near the malleoli and one or more of the following exists: (1) age 55 years or older; (2) inability to bear weight; or (3) bone tenderness at the posterior edge or tip of either malleolus. This study assessed the utility of the OAR on pediatric patients with acute ankle injuries. DESIGN: Prospective, consecutive survey of pediatric patients with acute ankle injuries. SETTING: Pediatric emergency department of an urban university hospital. PARTICIPANTS: Seventy-one children with acute ankle injuries were enrolled from July 22, 1993, to December 1, 1993. INTERVENTIONS: Twenty-four standardized clinical variables were assessed and recorded by physicians in the pediatric emergency department. The OAR were applied to each patient by the investigator to determine which ones would qualify for roentgenography. MAIN OUTCOME MEASURES: Sensitivity and specificity of the OAR were calculated, as was percent reduction in roentgenograms ordered. RESULTS: Seventy-one of 73 eligible patients were enrolled. The two missed patients had open fractures of the tibia. Sixty-eight of 71 patients had ankle roentgenography during the visit. Fourteen patients (21%) (mean age, 11.8 +/- 4.0 years) had fractures noted on the roentgenograms. Fifty-four patients (79%) (mean age, 12.0 +/- 3.6 years) had no fracture. Application of the OAR would have reduced the number of roentgenograms ordered by 25% without missing any fractures. Sensitivity of OAR was 100% (95% confidence interval, 77% to 100%), specificity was 32% (95% confidence interval, 21% to 43%), negative predictive value was 100% (95% confidence interval, 80% to 100%), and positive predictive value was 28% (95% confidence interval, 17% to 39%). CONCLUSIONS: Initial testing suggests that the OAR may help determine which children with acute ankle injuries could safely forgo roentgenograms without risk of missing fractures.

Acute Disease↗
PubMed1975

Screening for bone metastases. Are only scans necessary?

The results of total skeletal scintigraphy with technetium 99m-labeled diphosphonate in 200 patients with biopsy-proven primary cancer demonstrated abnormalities in 114; 57 had normal roentgenograms. In 32 of the 57 patients, the abnormalities were ascribed to malignant lesions. This is a false-negative rate of 17% for the roentgenographic examinations. Only three patients had abnormal roentgenograms but normal scans, a yield of 1.6% false-negative scans. In a comparison of scan and roentgenographic findings with the skeleton divided into 12 regions, 119 of 160 abnormalities seen on scans but not on roentgenograms were attributed to tumor. Only five of 17 regions that were abnormal on roentgenogram but not on scans were unexplained false-negative findings. Thus, on a regional basis, the yields of false-negative roentgenograms and scans were 9.1% and 0.4%, respectively.

Bone Neoplasms↗
PubMed1993

Accuracy of lung imaging in metastases with implications for the role of thoracoscopy.

Thoracoscopy for wedge resection of lung metastases is rapidly increasing in frequency. This technique precludes bimanual palpation of the lung to locate additional lesions not seen on the surface. Finger palpation is inadequate. Implications regarding the failure to identify all metastases and the negative impact on long-term survival led us to review retrospectively the correlation between pathologic findings and imaging reports. One hundred forty-four patients who had resection of lung metastases from colorectal cancer were studied. All had chest roentgenograms and 72 had computed tomographic scans as well. Chest roentgenogram and computed tomographic reports differed in the number of nodules reported in 17 of 72 patients (24%). In 3 of 17 patients chest roentgenogram showed more nodules than computed tomography. Chest roentgenogram differed from pathologic findings at surgery in 57 of 144 patients (39%). Twenty-six of 57 patients (46%) had more lesions than chest roentgenogram detected and 31 had fewer. Computed tomographic scans differed from pathologic findings in 30 of 72 patients (42%). If one or two lesions were imaged, 12 patients had fewer cancers (some lesions were benign) and 18 had more cancers than computed tomography reported; computed tomographic scans erred 28% of the time. The inability to adequately palpate the entire lung using the thoracoscope alone markedly impairs the surgeon's ability to know if a resection of all lesions has been done. The validity of using thoracoscopy resection in the management of metastatic disease is seriously questioned other than for diagnosis.

Colorectal Neoplasms↗
PubMed2004

Chest computed tomography in the staging of pancreatic and periampullary carcinoma.

BACKGROUND: Staging of the tumours in the pancreas and periampullary region usually consists of abdominal computed tomography (CT). Laparoscopy is also advocated. Little attention has been paid to extra-abdominal staging. In addition to peritoneal, lymphatic and hepatic metastases, lung metastases are frequently found. The chest CT scan has been demonstrated as better than the plain chest roentgenogram or conventional tomography in demonstrating lung tumours. This study was done to evaluate whether the chest CT scan gives information additional to the plain chest roentgenogram in the staging of pancreatic and periampullary tumours. METHODS: Fifty-three patients with a pancreatic or periampullary tumour underwent helical CT scan of the chest in addition to the abdominal CT scan. The CT scans and the chest roentgenograms were read separately without the result of the other being known; the results were compared with each other and with the clinical and operative findings. RESULTS: In the chest CT scan, 7 out of 53 (13%) patients had nodules in the lungs. The chest pathologies were not seen in the chest roentgenogram except for pneumonia in one patient and lung tumours in another (sensitivity of the chest roentgenogram 2/7 = 29%). Liver metastasis, local invasion of the tumour or poor general condition of the patient made lung biopsy or bronchoscopy unnecessary or impossible. CONCLUSION: Lung metastases seldom appear in patients with pancreatic or periampullary carcinoma without other contraindications for resection, which is why the chest CT scan cannot be recommended in the staging of these tumours for operation.

Aged↗
PubMed2001

Roentgenographic findings in the cervical spine in asymptomatic persons: a ten-year follow-up.

STUDY DESIGN: The lateral roentgenographic findings in 159 initially asymptomatic persons were reviewed at a 10-year interval. A questionnaire was used at the time of the last roentgenogram to determine the incidence of pain. OBJECTIVES: To identify the number of persons who experienced pain during that 10-year period, describe the roentgenographic changes, and determine the association between the development of symptoms and roentgenographic findings. SUMMARY OF BACKGROUND DATA: It is well established that degenerative changes of the cervical spine increase with age and may occur in asymptomatic persons. However, it is unknown whether pain is more likely to develop in persons with degenerative changes than in those with normal roentgenograms. METHODS: Lateral cervical roentgenograms were obtained in 200 asymptomatic persons, 100 women and 100 men, to obtain normal values of cervical lordosis and degenerative changes in persons aged 20-65 years. Ten years later, 159 participants had repeat roentgenograms and were administered a questionnaire regarding the presence or absence of pain. RESULTS: There was an increase in the number of subluxations and an increase in degenerative changes. Pain developed in 15% of participants in the 10-year interval. The presence of degenerative changes at C6-C7 on the initial roentgenogram was a statistically significant predictor of pain. CONCLUSION: With age, there is an increase in the number of subluxations and the incidence and severity of degenerative changes. Pain is more likely to develop in persons with degenerative changes at C6-C7.

Adult↗
PubMed1993

Effect of knee angle and ligament insufficiency on anterior tibial translation during quadriceps muscle contraction: a preliminary report.

Additional information is needed regarding the effects of exercise protocols on the injured or reconstructed anterior cruciate ligament (ACL). The purpose of this investigation was to assess the effects of knee flexion angle and ACL insufficiency on anterior tibial translation (ATT) and patellar ligament insertion angle as subjects performed maximal isometric quadriceps muscle contractions. The subjects were two females and two males between the ages of 18 and 24 who had sustained injuries that resulted in unilateral ACL insufficiency. Each subject performed maximum isometric quadriceps muscle contractions with each leg on a Cybex II dynamometer at each of three positions: 15, 45, and 75 degrees knee flexion. A lateral knee roentgenogram was obtained as each subject maintained each isometric muscle contraction. A roentgenogram also was taken as subjects rested each knee in each of the three target positions. Anterior tibial translation for each isometric muscle contraction was assessed by measuring the anterior displacement of the tibial plateau on the isometric resisted roentgenogram relative to the resting roentgenogram. Patellar ligament insertion angle also was measured for each roentgenogram. Maximum ATT occurred at the 15 degrees knee flexion target angle for two subjects and at the 45 degrees target angle for the other two subjects. Patellar ligament insertion angle decreased as knee flexion angle increased. Appreciable stress may be imposed on the ACL as patients perform maximum quadriceps muscle contractions in positions of terminal knee extension and in midrange positions previously reported as being safe for maximal effort quadriceps exercise. Magnitude of stress imposed on the ACL is discussed as a function of the length-tension relationship of the quadriceps muscle-tendon unit and insertion angle of the patellar ligament. Suggestions are made for additional research regarding appropriate muscle strengthening protocols for patients who have undergone ACL reconstruction.

Adolescent↗
PubMed1992

[A case of chronic necrotizing pulmonary aspergillosis].

A 70-year-old woman with diabetes mellitus who was following a therapeutic diet showed an infiltrative shadow in the right upper lung field on chest roentgenogram in April, 1986. She was diagnosed as having pneumonia and was treated for five months with several antibiotics, but the abnormal shadow on chest roentgenograms increased in size. Therefore, she was admitted to our hospital in October 1986. Although tubercle bacilli were not isolated from her sputum or from materials obtained by bronchoscopic examination, we made an initial diagnosis of pulmonary tuberculosis based on the findings of chest roentgenograms, tomographs and CT scanning. In spite of treatment with antituberculous drugs, the infiltrative shadow with cavity on chest roentgenograms continued to increase in size, and the patient developed occasional hemoptysis. Percutaneous needle biopsy was performed in February 1987 to establish a definite diagnosis, and the presence of Aspergillus fumigatus was confirmed by microscopic examination and culture. After treatment with miconazole and 5-FC for 3 to 4 months, the abnormal shadow on the chest roentgenogram gradually disappeared and was almost undetectable one year later. The clinical course of this patient was considered to be strongly indicative of chronic necrotizing pulmonary aspergillosis, which was described by Binder et al. in 1982.

Aged↗
PubMed1990

Magnetic resonance imaging and computer tomography of acute spinal cord trauma.

Spinal cord lesions are not detectable on roentgenograms and computed tomography (CT) scans. Magnetic resonance images (MRIs) are able to make soft-tissue lesions visible. Interpretations of MRIs, CT scans, and roentgenograms were compared in 25 patients and three postmortem specimens with spinal cord injuries. In 14 patients and one specimen with normal roentgenograms and CT scans, the MRI demonstrated ten soft-tissue injuries as minimal displacement of the vertebral bodies or as a high signal intensity in the disc space, indicating a hematoma. Seven of the ten patients demonstrating soft-tissue injuries also had an intramedullary lesion, while in five of the 15 patients with normal CT scans, only a medullary lesion was present on MRI. In 11 patients and two postmortem specimens, fractures were seen on roentgenograms and CT scans. In these patients, the CT was superior to the MRI in detecting small bony fragments, but the medullary lesions were visible only on the MRIs. An intramedullary low signal intensity corresponded to macroscopically visible hemorrhages in the three postmortem specimens. The MRI provided important information in patients with neurologic deficits. No obvious pathologic changes were evident on the roentgenograms and CT scans. The MRI also demonstrated intramedullary and extramedullary soft-tissue lesions and was useful in establishing a diagnosis and in choosing appropriate therapy. CT, on the other hand, was superior in detecting small bony fragments and fracture lines.

Acute Disease↗
PubMed1989

Fracture of the upper ribs and injury to the great vessels.

Although individual reports have indicated that a fracture of the first or second rib is predictive of injury to the thoracic aorta and its major branches, the results of a careful review of the literature do not support this contention. In patients suffering blunt trauma, the risk of disruption of the aorta is not greater in patients with fracture of the upper two ribs, compared with victims of trauma with fracture of other ribs or those without fracture of ribs. Clinical manifestations are often absent in patients with disruption of the aorta or the innominate artery, but evidence of mediastinal hemorrhage is almost always present on roentgenograms of the chest. Widening of the mediastinum may not be apparent, but obliteration of the normal aortic contour is a sensitive finding in aortic transection. Injury to the subclavian or carotid artery nearly always produces clinical or roentgenographic signs, or both. After blunt trauma to the chest, patients with fracture of the first or second rib without clinical signs of vascular injury and evidence of mediastinal hemorrhage on thoracic roentgenograms (with the patient in an upright position when possible) do not need aortography to exclude occult vascular injury. A few patients with injury to the great vessels may have a normal thoracic roentgenogram on initial presentation to the hospital. After the correction of hypovolemia and stabilization of hemodynamic status, evidence of mediastinal bleeding should become apparent on subsequent thoracic roentgenograms. Repeat examinations must be performed and serial roentgenograms of the chest must be obtained for several days after injury to assess the possibility of unrecognized vascular trauma. If clinical or roentgenographic evidence of vascular injury is revealed, arteriography is mandatory. Thoracic CT scanning in patients with evidence of mediastinal hemorrhage on plain film may be of value in selecting patients for angiography, but additional experience must be obtained before such a protocol becomes an established policy.

Aorta, Thoracic↗
PubMed1989

[A case of sarcoidosis beginning with extensive ground-glass pattern on chest X-ray, accompanied with high fever and eosinophilia].

A 62-year-old woman was admitted to our hospital with a chief complaint of dyspnea on effort. Her temperature was 38 approximately 39 degrees C. Eosinophilia was seen in peripheral blood and the chest roentgenogram showed bilateral extensive ground-glass pattern, accompanied by air bronchogram. The extensive shadow fitted the description of "unstable shadow." Transbronchial lung biopsy specimens demonstrated the formation of non-caseating epithelioid cell granulomas with severe alveolitis and exudative change in alveolar spaces. In bronchoalveolar lavage fluid (BALF), the total cell count was normal but the lymphocyte population was increased to 28%. Pathological findings were suggestive of either sarcoidosis or hypersensitivity pneumonitis. Prednisolone therapy was started. As a result, her symptoms rapidly disappeared and the chest roentgenogram showed remarkable improvement for a short period. However skin lesions on bilateral lower extremities appeared after approximately one month from discontinuation of prednisolone. Skin biopsy specimens showed non-caseating epithelioid cell granulomas leading to the final diagnosis of sarcoidosis. About one month after the appearance of the skin lesion, the chest roentgenogram findings deteriorated. At this time, the BALF eosinophil population surprisingly increased to 24.9%. Chest roentgenogram showed rapid improvement again by administration of prednisolone. This case was considered to be a unique case of sarcoidosis from the point of view of the chest roentgenogram pattern, eosinophilia, clinical course and presence of severe alveolitis with exudative change in alveolar spaces.

Alveolitis, Extrinsic Allergic↗
PubMedDate not supplied

Lateral roentgenography in the diagnosis and treatment of dysplasia/dislocation of the hip.

The author emphasizes the importance of true lateral and multiple-position roentgenograms in providing a more comprehensive demonstration of the pathology, the attainment of reduction and the surgical alterations which are necessary to maintain a congruous reduction. A simple convenient technique for lateral roentgenography of the hip in children is presented. A series of cases with roentgenograms is also presented to demonstrate the value of the lateral roentgenograms. The horizontal lateral roentgenogram simulates the position of the upright human stance, and thus, depicts malocclusion, which may be seen when anteversion is present. Even though the anterior view depicts sphericity and apparent coverage, the lateral roentgenogram may show malocclusion which may lead to degenerative changes later in life. It is the author's belief that the treatment of children's hip conditions will show improved long-term results if predicated on the comprehensive x-ray examination outlined in this article.

Child↗
PubMed1988

An analysis of the biomechanical mechanism of tibial stress fractures among Israeli infantry recruits. A prospective study.

The biomechanical mechanism of tibial diaphyseal stress fractures was studied prospectively in a group of 286 Israeli recruits. Before training each recruit had roentgenograms taken of his tibiae. Measurements of total tibial and cortical widths in the anteroposterior (AP) and mediolateral planes were made on these roentgenograms at two levels: at the point of the narrowest tibial width on AP roentgenograms (Level 1) and at the point of the narrowest width on lateral roentgenograms (Level 2). The tibial cross section was idealized as an eccentric ellipse within an ellipse, and on the basis of measurements taken from the roentgenograms, the cross-sectional area (compression strength), area moments of inertia about AP and mediolateral axes of bending (bending strength), and the area polar moment of inertia (torsional strength) were calculated for each cross section. During the course of 14 weeks of training, 20% of the recruits sustained tibial diaphyseal stress fractures, all of which were along the medial cortex. Using stepwise logistic regression analysis the tibia's bending strength along an AP axis of bedding at Level 2 was found to be the most significant factor determining whether or not a recruit would develop a tibial stress fracture.

Adult↗
PubMed1995

Sensitivity to change of various roentgenological severity scoring systems for osteoarthritis of the hip.

RATIONALE: joint space assessment on roentgenograms is considered reliable for evaluating the anatomic severity of hip osteoarthritis. Methods for measuring this parameter include the scoring system developed by Kellgren and Lawrence, joint space width measurement, and joint space surface area measurement after digitalization of roentgenograms. OBJECTIVE: to compare the sensitivity to change of the three above-listed methods. PATIENTS AND METHODS: the study included patients with hip osteoarthritis meeting ACR criteria for whom two roentgenograms showing evidence of hip osteoarthritis taken 10 to 15 months apart were available. Roentgenograms were read by a single investigator who was unaware of the chronological order of films. Sensitivity to change of the three measurement techniques was determined by calculating standardized response mean (mean change/standard deviation of change). RESULTS: the study evaluated 34 hips (68 roentgenograms) in 22 patients (12 females and ten males, mean age 63 +/- 10 years) with osteoarthritis of one (n = 10) or both (n = 12) hips. Standardized response mean were 0.37, 0.33, and 0.16 for joint space width, joint space surface area, and the Kellgren-Lawrence score, respectively. CONCLUSION: this study suggests that joint space width or surface area may be more sensitive than the Kellgren-Lawrence score for monitoring the course of hip osteoarthritis.

Aged↗
PubMed1994

Sternal dehiscence. Early detection by radiography.

A study was conducted to look for radiographic indicators that might provide a clue to threatened separation of the median sternotomy closure. To evaluate this problem, we studied two groups of patients. In group A the postoperative plain chest roentgenograms of 50 consecutive patients having cardiac operations were reviewed until the time of their complete recovery from the operation. Sternal problems were not identified in these patients clinically. However, chest roentgenograms showed that one patient had a displaced sternal wire and another had a classic sternal separation as judged by the change in wire topography. In the second series of patients, group B, 10 patients with clinical separation of the sternum were similarly evaluated. In seven of the 10 an early subtle change in position of one or more sternal wires preceded clinical detection of separation by 1 to 8 days, and a gross change in the sternal wire positions preceded clinical diagnosis in five patients by 1 to 6 days. The appearances of the wires by roentgenogram showed four common patterns. These findings indicate that thoracic surgeons and radiologists alike do not always carefully examine the appearance of the sternal wires on the postoperative roentgenograms. Subtle changes or gross changes in the position of the wires is an indicator of sternal separation. Therefore, the topography of the sternal wires should be scrutinized along with the other postoperative changes seen on roentgenograms after median sternotomy.

Bone Wires↗
PubMed1993

Applicability of the Greulich and Pyle skeletal age standards to black and white children of today.

OBJECTIVE: The Greulich and Pyle skeletal age atlas was derived from white children of upper socioeconomic level during the 1930s. To our knowledge, the Greulich and Pyle standards have not been reassessed for both black and white children; it was the purpose of this study to reassess the applicability of these standards to today's children. DESIGN: A "blinded" review of hand roentgenograms taken for the evaluation of trauma was performed. Age of the subjects was evenly distributed between 0 and 18 years. The roentgenograms were scored for bone age by five individuals from different disciplines and levels of training. The difference between the median bone age and the child's chronologic age was calculated for each roentgenogram and stratified into four age groups: early childhood (0 to 4 years), middle childhood (4 to 8 years), late childhood (8 to 13 years), and adolescence (13 to 18 years). SETTING: The roentgenograms were obtained from four hospital emergency rooms in the Lake Erie basin area, the same geographic area from which the Greulich and Pyle standards originated. PATIENTS: There were 841 children: 452 boys and 389 girls, 461 black and 380 white children. RESULTS: The bone ages and chronologic ages were similar for white girls of all ages. Black girls were skeletally advanced by 0.4 to 0.7 year (P < .001), except during middle childhood. White boys were skeletally delayed during middle childhood by 0.9 year (P < .001) and during late childhood by 0.4 year (P < .01), but they were advanced during the adolescent years by 0.5 year (P < .01). Black boys showed no difference except for the adolescent group, which was skeletally advanced by 0.4 year (P < .02). CONCLUSIONS: The Greulich and Pyle atlas is not applicable to all children today, especially black girls. We should be aware of this information when making clinical decisions requiring accurate bone ages.

Adolescent↗
PubMed2006

Smoking and degenerative changes of the cervical spine: a roentgenographic study.

BACKGROUND CONTEXT: Cigarette smoking has been implicated in low back pain and intervertebral disc degeneration; however, there is no conclusive evidence that cigarette smoking is an important contributing factor to intervertebral disc degeneration. PURPOSE: The objective of this study is to determine whether heavy cigarette smoking is a contributing factor to the development and severity of degenerative disc disease of the cervical spine. STUDY DESIGN: This is a comparative roentgenographic study of degenerative changes of the cervical spine in age- and sex-matched smokers and nonsmokers. PATIENT SAMPLE: Two hundred asymptomatic subjects, 100 women and 100 men, were equally divided into 50 nonsmokers and 50 heavy smokers. OUTCOME MEASURES: A numerical grading system previously developed was used to grade the presence and severity of degenerative changes at each cervical level, and cervical lordosis was measured. This was performed on a lateral cervical spine roentgenogram. METHODS: A single lateral roentgenogram of the cervical spine was taken in each individual, and in the smokers a short questionnaire was administered to determine the amount and duration of smoking. The roentgenograms were read by the three authors. Average values of all three observers were used for statistical analysis. RESULTS: There were no statistically significant differences between smokers and nonsmokers. CONCLUSIONS: Based on the evidence of the plain roentgenograms used in this study, we found no evidence to suggest that cigarette smoking is a causative factor in asymptomatic people in the development of degenerative disc disease in the cervical spine. Whether cigarette smoking has a significant effect in people with neck symptoms cannot be determined by this study.

Cervical Vertebrae↗