MRI kinematic analysis of T1 sagittal motion between cervical flexion and extension positions in 145 patients

  • Koji Tamai
  • Zorica Buser
  • Permsak Paholpak
  • Kittipong Sessumpun
  • Patrick C. Hsieh
  • Hiroaki Nakamura
  • Jeffrey C. Wang
Original Article



Although the T1 vertebra is considered as an important factor of cervical balance, little is known about its motion between flexion and extension. The purpose of present study was to analyze the T1 sagittal motion using kinematic magnetic resonance imaging (kMRI), and to identify factors that relate to T1 sagittal motion.


We retrospectively analyzed 145 kMR images taken in weight-bearing neutral, flexion and extension positions. Cervical balance parameters were evaluated in each position. The degree of T1 sagittal motion was defined as [(T1 slope at extension) − (T1 slope at flexion)]. All patients were divided into three groups: Positive group (T1 followed the head motion, T1 sagittal motion > 5°), Stable group (5 ≥, ≥ − 5) and Negative group (T1 moved in the opposite direction from the head motion, > − 5). The groups were compared and multivariate logistic regression analysis was calculated.


There were 57 (40%) patients in the positive, 56 (39%) in the stable and 32 (22%) in the negative group. The positive group had the largest C2–7 sagittal vertical axis in flexion (p < 0.001) and the shortest in the extension (p = 0.023). Similar trends were seen in cranial tilt and cervical tilt. The value of T1 height < 27 mm was a significant independent factor for the negative group (p = 0.008, adjusted odds ratio = 5.958).


Based on T1 sagittal motion, 40% of the patients were classified in positive group (the T1 vertebra followed the head motion in flexion and extension), and 20% were classified in the negative group (the T1 vertebra moved in the opposite direction from the head motion). T1 height < 27 mm was a potential predictor of negative group.


Kinematic magnetic resonance imaging T1 slope T1 sagittal motion Cervical sagittal balance T1 height 


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  • Koji Tamai
    • 1
    • 3
  • Zorica Buser
    • 1
  • Permsak Paholpak
    • 1
  • Kittipong Sessumpun
    • 1
  • Patrick C. Hsieh
    • 2
  • Hiroaki Nakamura
    • 3
  • Jeffrey C. Wang
    • 1
  1. 1.Department of Orthopaedic SurgeryKeck School of Medicine, University of Southern CaliforniaLos AngelesUSA
  2. 2.Department of Neurological Surgery, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesUSA
  3. 3.Department of Orthopedics, Graduate School of MedicineOsaka City UniversityOsakaJapan

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