Background: The sagittal vertical axis (SVA) is important in the evaluation of spinal sagittal balance. Although the "fists-on-clavicles" (FOC) position has been widely used in radiographic examinations, it does not define shoulder flexion in detail. Meanwhile, in EOS imaging, the "hands-on-cheeks" (HOC) position is widely used but has not been well investigated. The purpose of this study was to investigate the relative usefulness of FOC and HOC in investigating SVA.
Materials and methods: Mean SVA was measured by EOS imaging using standing lateral radiographs of 34 volunteers in four different positions: relaxed (RLX), shoulder flexion at 90° with FOC (FOC90), elbows touching the trunk with FOC (FOCET), and HOC.
Results: The mean SVA was 2.0 ± 2.1 cm in RLX; -1.4 ± 3.2 cm in FOC90; -0.5 ± 3.0 cm in FOCET; and -0.2 ± 2.9 cm in HOC. The negative shift from RLX was significantly greater in FOC90 than in FOCET (-3.4 ± 2.2 vs -2.5 ± 2.4 cm; p = 0.0182). The negative shift from RLX in HOC was almost equal to that in FOCET; the difference was 0.3 cm (-2.2 ± 2.2 vs -2.5 ± 2.4 cm; p = 0.2560).
Conclusion: FOC90 showed a negative SVA shift in comparison with FOCET. The difference in the mean SVA between HOC and FOCET was 0.3 cm, a clinically small difference.
Keywords: Arm position; EOS imaging; Fists-on-clavicles; Hands-on-cheeks; Lateral radiographic evaluation; Sagittal vertical axis.