The seventh cervical vertebra is an appropriate landmark for thoracic kyphosis measures using distance from the wall

Arpassanan Wiyanad; Sugalya Amatachaya; Pipatana Amatachaya; Patcharawan Suwannarat; Pakwipa Chokphukiao; Thanat Sooknuan; Chitanongk Gaogasigam

doi:10.1142/S1013702523500038

The seventh cervical vertebra is an appropriate landmark for thoracic kyphosis measures using distance from the wall

Hong Kong Physiother J. 2023 Jun;43(1):43-51. doi: 10.1142/S1013702523500038. Epub 2023 Jan 25.

Authors

Arpassanan Wiyanad^{1

2

3}, Sugalya Amatachaya^{1

2

4}, Pipatana Amatachaya^{2

5

6}, Patcharawan Suwannarat^{2

7

8}, Pakwipa Chokphukiao^{2

9

10}, Thanat Sooknuan^{2

11

12}, Chitanongk Gaogasigam^{2

13

14}

Affiliations

¹ School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand.
² Improvement of Physical Performance and Quality of Life (IPQ) Research Group, Khon Kaen University, Khon Kaen 40002, Thailand.
³ arpassanan@kkumail.com.
⁴ samata@kku.ac.th.
⁵ pipatana.am@rmuti.ac.th.
⁶ pipat_24@hotmail.com.
⁷ Department of Physical Therapy, School of Integrative Medicine, Mae Fah Luang University, Chiang Rai, Thailand.
⁸ patcharasuwannarat@gmail.com.
⁹ Department of Physical Therapy, Faculty of Allied Health Sciences, Naresuan University, Phitsanulok, Thailand.
¹⁰ pakwipa.ch@gmail.com.
¹¹ Department of Electronics Engineering, Faculty of Engineering and Architecture, Rajamangala University of Technology Isan, Nakhon Ratchasima, Thailand.
¹² thanat@rmuti.ac.th.
¹³ Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand.
¹⁴ chitanong.g@chula.ac.th.

Abstract

Background: Hyperkyphosis is frequently found nowadays due to the change in current lifestyles and age-related system decline. A simple hyperkyphosis measurement can be made easily using the perpendicular distance from the landmark to the wall. However, the existing evidence applied two different landmarks [occiput and the seventh cervical vertebra (C7)] and the measurement using rulers was susceptible to error due to their misalignment.

Objective: To assess an appropriate landmark for thoracic kyphosis measurement using distance from the wall (KMD), by comparing between occiput and C7, as measured using rulers and verified using data from a specially developed machine, the so-called infrared-gun kyphosis wall distance tool (IG-KypDisT), and the Cobb angles.

Methods: Community-dwelling individuals with a risk of thoracic hyperkyphosis (age $\geq 10$ years, $n = 43$ ) were cross-sectionally assessed for their thoracic hyperkyphosis using the perpendicular distance from the landmarks, occiput and C7, to the wall using rulers and IG-KypDisT. Then the Cobb angles of these participants were measured within seven days.

Results: The outcomes from both landmarks differed by approximately 0.8 cm ( $p =$ 0.084). The outcomes derived from C7 were more reliable (ICCs>0.93, $p <$ 0.001), with greater concurrent validity with the radiologic data ( $r =$ 0.738, $p <$ 0.001), with the overall variance predicted by the regression models for the Cobb angles being higher than that from the occiput (47-48% from C7 and 38-39% from occiput). The outcomes derived from rulers and IG-KypDisT showed no significant differences.

Conclusion: The present findings support the reliability and validity of KMD assessments at C7 using rulers as a simple standard measure of thoracic hyperkyphosis that can be used in various clinical, community, and research settings.

Keywords: Cobb angle; Dowager’s hump; Round back; radiology; spine.