Innovations in Cervical Spine Imaging: A Systematic Review Assessing the Value of Oblique Imaging Techniques

Introduction: Traditional cervical spine MRI and CT scans use straight lateral views that may inadequately visualize neural foramina and facet joints, potentially underestimating pathologies like foraminal stenosis. Oblique sagittal imaging offers enhanced visualization and may improve diagnostic accuracy and clinical outcomes.

Methods: We conducted a systematic review per PRISMA guidelines, searching PubMed and Google Scholar (January–February 2024) for studies comparing oblique sagittal and straight lateral views in cervical spine MRI and CT imaging. Inclusion criteria targeted empirical studies providing direct comparisons or relevant data. Extracted data included patient demographics, image clarity, diagnostic accuracy, anatomic coverage, interpretability, inter-observer reliability, and patient outcomes. Quantitative summary statistics and qualitative analyses identified trends and consensus.

Results: Thirty-three studies (1982–2023) involving 1,519 patients (mean age 52 ± 9 years; range 25–76) were included, with an average sample size of 51. Among studies reporting sex (n=31), 745 were male and 575 female. Out of 32 studies assessing image clarity, 30 studies (~93.8%) reported that oblique sagittal imaging enhanced image quality compared to straight lateral views. Additionally, oblique imaging improved diagnostic accuracy in detecting foraminal stenosis and nerve root impingement in 28 studies. Inter-observer reliability was enhanced in 22 studies, with kappa values rising from “slight” (κ = 0.20) to “fair” or “moderate” (κ = 0.40–0.60). Improved interpretability led to more accurate diagnoses and positively influenced clinical decision-making and patient outcomes.

Conclusion : Oblique cervical spine imaging offers superior image clarity, diagnostic accuracy, and anatomic visualization over straight lateral views. Given these benefits without added costs or time, spine surgeons may consider incorporating oblique cervical spine imaging into routine practice and standard imaging protocols. Additionally, neuroradiologists may adopt these techniques to enhance diagnostic efficacy and improve patient outcomes.