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CLEAR X-Ray Analysis
2013
Dr. Dennis Woggon BSc, DC
X-rays from Dr. Nathan Wagner, DC
Edited by Dr. Kaila Hersh, DC
Dr. SuYen Chong, DC
copyrighted 2013
Lateral
Cervical
Neutral
LCN
Sella Turcica – anterior, superior
aspect of ST
Eye
Level
Line
Parallel
to top of
film
C2
Superior
Stress
Line
C7
Inferior
Stress
Line
Superior
and
Inferior
aspect of
the back
of the
Vertebral
Body
C2
Superior
Stress
Line
C7
Inferior
Stress
Line
Where
the
Superior
Stress
Line
and the
Inferior
Stress
Line
Cross is
the
Stress
Vertebra
Normal
C4-5
Measure
the
intersection
of the
superior
and inferior
stress lines
in degrees
43 degrees
5% LOC
Convert the
degrees to
a
percentage
of Loss Of
Curve
Kyphotic
Neck
Superior
& Inferior
Stress
Lines
Kyphotic
Neck
Measure
The
Reversed
Angle
Kyphotic
20 degrees
146% LOC
Convert the
degrees to
a
percentage
of Loss Of
Curve
Kyphotic
S-Curve
The
Superior
&
Inferior
Lines Don’t
Cross
Kyphotic
S-Curve
Find The
Middle Line
That Best
Approximates
The Vertebra
Kyphotic
S-Curve
Measure
The
Kyphotic
Angle and
Convert It
Into %
Kyphotic
11 degrees
126% LOC
Kyphotic
S-Curve
Measure
The
Lordotic
Angle and
Convert It
Into %
Lordotic
28 degrees
38% LOC
Kyphotic
S-Curve
Add The %
Together
126% +
38% =
164% LOC
Convert the
degrees to
a
percentage
of Loss Of
Curve
126% +
38% =
164% LOC
Lordotic
S-Curve
Lordotic
S-Curve
The
Superior
&
Inferior
Lines
Don’t
Cross
Lordotic
S-Curve
Find The
Middle Line
That Best
Approximates
The Vertebra
Lordotic
S-Curve
Lordotic
26 degrees
Lordotic
S-Curve
Kyphotic
9 degrees
Lordotic
S-Curve
Add The %
Together,
NOT the
degrees
Lordotic 26°
Kyphotic 9°
Convert the
degrees to
a
percentage
of Loss Of
Curve
43% +
122% =
165% LOC
Lordotic
S-Curve
Add The %
Together
Lordotic
S-Curve
Add The %
Together
26° – 43%
9° – 122%
Total = 165%
LOC
Sella Turcica – anterior, superior
aspect of ST
Sella Turcica – anterior, superior
aspect of ST
Gravitational
Weight Line
Sella Turcica – anterior, superior
aspect of ST
Perpendicular
to the top of
the film
Gravitational
Weight Line
Gravitational
Weight Line
Should
cross the
C4/C5
interspace
at the ¼
aspect
Gravitational
Weight Line
1” = 10#’s
.2” = 2#’s
Total of 12#’s
Apparent
Head Weight
Skull Base
Line
Zygomatic
Notch and
½”
posterior
to the
mastoid
Zygomatic
Notch
Skull
Base
Line
Atlas
Plane
Line
Center of
Anterior
Tubercle
and in
front of
the
Posterior
Tubercle
Atlas
Plane
Line
Skull
Base
Line
Atlas
Plane
Line
Superior
Stress
Line
Superior
and
Inferior
aspect of
the back
of the
Vertebral
Body
Superior
Stress
Line
Superior
Stress
Line
Measure
the Skull
Base Line
to the
Superior
Stress Line
18 degrees
18 72
Measure
the Atlas
Plane Line
to the
Superior
Stress Line
21 degrees
21 69
18 72
Normal
position is 18
degrees to the
perpendicular
protractor line
and superior
stress line
or
72 degrees
between the
skull base line
and the
superior stress
line
18 72
Normal
position is 18
degrees to the
perpendicular
protractor line
and superior
stress line
or
72 degrees
between the
skull base line
and the
superior stress
line
Skull
Base Line
18
degrees
or
72
degrees
21 69
Normal
position is 18
degrees to the
perpendicular
protractor line
and superior
stress line
or
72 degrees
between the
atlas plane
line and the
superior stress
line
21 69
Normal
position is 18
degrees to the
perpendicular
protractor line
and superior
stress line
or
72 degrees
between the
atlas plane
line and the
superior stress
line
Atlas
Plane
Line
21
degrees
or 69
degrees
Inferior
Atlas of
3 degrees
Superior
Stress
Line
38
C2 Vertebral
Body Base
Lines
C2 VBBL
The Normal
Position of C2
should be -10
degrees to a
horizontal
plane line
-1
The Normal
Position of
C2 should be
-10 degrees
to a
horizontal
plane line
C2
measures
– 1 degrees
so it is 9
degrees
out of
alignment
-1
Vertebral
Body Base
Lines
VBBL
Vertebral
Body Base
Lines
Should all
converge
at 6 inches
Posterior
Articular
Dysfunctional
Vertebra
C2, C4, C7
PADV
The weight
of the head
causes a
cantilever
effect on the
vertebra
causing the
posterior
vertebra to
diverge
The weight
of the head
causes a
cantilever
effect on the
vertebra
causing the
posterior
vertebra to
diverge
The weight
of the head
causes a
cantilever
effect on the
vertebra
causing the
posterior
vertebra to
diverge
Vertebral
Body Base
Lines
Should all
converge at
6 inches
Posterior
Vertebra
C2 , C4, C7
SBL 18° / 72 °
APL 21 ° / 69 °
16% LOC
12# AHW
PADV
C 2, 4 & 7
Stress
Vertebra
C 5
Flexion
X-ray
Normal
Flexion
from
C2 – C7 is
60 degrees
28 degrees
of flexion
Skull
Base
Line
Atlas
Plane
Line
Superior
Stress
Line
The Skull
Base Line
relative
to the
superior
stress line
should be
3 degrees
in flexion
25
degrees
The Atlas
Plane
Line
relative
to the
superior
stress line
should be
10 ½
degrees
in flexion
11
degrees
Vertebral
Body
Base
Lines
Should
All
Diverge
C5, 6, 7
restricted
in flexion
Loss of
Motion
Segment
Integrity
Flexion
28 degrees
(60
normal)
Occiput 25
(3 normal)
Atlas 11
(10 ½
normal)
C5,6,7
restricted
in Flexion
Normal
Extension
from
C2 – C7
is 70
degrees
62
degrees of
Extension
Skull
Base
Line
Atlas
Plane
Line
Superior
Stress
Line
The Skull
Base Line
relative
to the
superior
stress line
should be
33
degrees
in
extension
42
degrees
The Atlas
Plane
Line
relative
to the
superior
stress line
should be
25 ½
degrees
in
extension
24
degrees
Vertebral
Body Base
Lines
Should All
Converge
C3 &C 7
restricted
in
Extension
Loss of
Motion
Segment
Integrity
Add the flexion and extension translation together
3mm Flexion + 2mm Extension = 5mm of translation - LMSI
Extension
62 degrees
(70 normal)
Occiput 42
(33 normal)
Atlas 24
(25 ½
normal)
C3 & C7
restricted in
extension
Cervical
Dorsal
Nasium
X-Ray
A-P Open
Mouth
Eye Plane
Line
Eye Plane
Line
Eye Plane
Line
Eye Plane
Line
Eye Plane
Line
Atlas Plane
Line
Inferior
lateral
aspect of
the lateral
mass
Use the
superior
aspect of
the lateral
mass and
the
posterior
arch as
guidelines
Atlas Plane
Line
Inferior
lateral
aspect of
the lateral
mass
Eye Plane
Line
Lt 6 degree
Upper Angle
Acute
84
Obtuse
96
The occiput
moves
inferior on
the side of
atlas
laterality
creating an
acute angle
Bisect C2
body using
the indented
sides of C2
Measure the
C2 spinous
from the
center of the
C2 vertebral
body in mm’s
Bisect C2
body using
the indented
sides of C2
Measure the
C2 spinous
from the
center of the
C2 vertebral
body in mm’s
Lt 2 mm’s Lt 2 mm
spinous
Find the
center of
the spinal
canal by
bisecting
the
difference
between
the center
of C2 body
and the C2
spinous
Find the
center of
the spinal
canal by
bisecting
the
difference
between
the center
of C2 body
and the C2
spinous
The Spinal Canal
is found 3-D
between the
body and spinous
The Spinal Canal
is found 3-D
between the
body and spinous
Find the center of the
spinal canal by
bisecting the
difference between
the center of the
vertebra body and
the spinous of the
stress vertebra
FIVE SPOTS
Where is the stress
vertebra?
C2
Superior
Stress
Line
C7
Inferior
Stress
Line
C5
Find the center of the
spinal canal by
bisecting the
difference between
the center of the
vertebra body and
the spinous of the
stress vertebra
FIVE SPOTS
Where is the stress
vertebra?
Lower Angle
The Lower Angle is
the intersection of
the Atlas Plane Line
and the Lower Angle
Line (Superior Stress
Line)
Left 2 degrees
The Lower Angle is
the intersection of
the Atlas Plane Line
and the Lower Angle
Line
2
Find the center of the
spinal canal by
bisecting the
difference between
the center of the
vertebra body and
the spinous of the
stress vertebra
and T2
FIVE SPOTS
The Cervical Dorsal
Angle is the
intersection of the
Superior (lower
angle) and Inferior
Stress Lines
Right CD Angle
2 degrees
The CD Line (Inferior
Stress Line) Should
Go Through The
Center Of The Spinal
Canal Of T7
If Not, Measure the
Dorsal Upper Dorsal
Angle
Cervical
Dorsal
Line
DUD
Dorsal
Upper
Dorsal
Line
Base
Posterior
Lt
Base
Posterior
Dot on the
Glabella
Lt
Base
Posterior
Dot on the
middle of
the dens
Lt
Central
Skull Line
Lt
Transverse
Foramen
Lt
Atlas Plane
Line
Lt
Guide Lines
Posterior
Arch &
Lateral
Mass
Lt
Transverse
Foramen
Lt
The acute
angle is
anterior
rotation
The obtuse
angle is
posterior
rotation
Lt
The acute angle
is anterior
rotation
The obtuse
angle is
posterior
rotation
Relative to the
upper angle
Anterior
Left 6 degrees
Anterior
6 degrees
Lt
Eye Plane
Line
Lt 6 degree
Upper Angle
Acute
84
Obtuse
96
The acute angle
is anterior
rotation
The obtuse
angle is
posterior
rotation
Relative to the
upper angle
LEFT Anterior
6 degrees
Anterior
6 degrees
Lt
Lateral
Lumbar
X-Ray
Sacral Base
Line
Sacral Base
Line relative
to a
Horizontal
Plane Line
Sacral Base
Line relative
to a
Horizontal
Plane Line
Ferguson’s
Angle
Sitting
Normal is
31 degrees
Sacral Base
Line relative
to a
Horizontal
Plane Line
Ferguson’s
Angle
Sacral Base
Line = 20
degrees
Sacral Base
Line relative
to a
Horizontal
Plane Line
Ferguson’s
Angle
Sitting
31 degrees
is normal
20 degrees
Inferior
Stress Line
Inferior
Stress Line
Top and
Bottom of
the back of
L5
Inferior
Stress Line
Inferior
Stress Line
Sacral Line
1st Sacral
Segment
Sacral Line
1st Sacral
Segment
Sacral Line
1st Sacral
Segment
and Inferior
Stress Line
L5
Retrolisthesis
Posterior
Ligament
Instability
Sacral Line
1st Sacral
Segment
and Inferior
Stress Line
L5
Retrolisthesis
Posterior
Ligament
Instability
Sacral Line
1st Sacral
Segment
and Inferior
Stress Line
5 mm’s
Superior
Lumbar
Stress Line
Superior
Lumbar
Stress Line
Stress
Vertebra
L3 is Normal
L3
Superior
Lumbar
Stress Line
Superior
Lumbar
Stress Line
35 degrees
is normal
sitting
21 degrees
Superior
Lumbar
Stress Line
35 degrees
is normal
sitting
21 degrees
40% LOC
20 degrees
Sacral Base
Line
40% LOC
L5 Retro
5 mm
A-P Lumbar
A-P Lumbar
Left Hip
High - AS
Right Hip
Low - PI
A-P Lumbar
Right Wide
Elephant
Ear
Left Narrow
Elephant
Ear
Pelvic
Rotation
A-P Lumbar
Sacral Base
Line
+ 1 degree
High Sacrum
= Anterior
Hip (usually)
AS
A-P Lumbar
Spinal Canal
5 dots
Stress
Vertebra?
Superior
Lumbar
Stress Line
Stress
Vertebra
L3
A-P Lumbar
Spinal Canal
5 dots
Stress
Vertebra
L 3
A-P Lumbar
Spinal Canal
Inferior
Stress Line
A-P Lumbar
Spinal Canal
Acute
Lumbo
Sacral Angle
LEFT Acute
LS angle
2 degrees 2
A-P Lumbar
Spinal Canal
Superior
Stress Line
Stress
Vertebra
to T12
2
A-P Lumbar
Spinal Canal
Superior
Stress Line
Stress
Vertebra
to T12
A-P Lumbar
Spinal Canal
Superior
Stress Line
Stress
Vertebra
to T12
RIGHT
Lumbo
Dorsal
Angle
5 degrees 5
A-P Lumbar
Spinal Canal
Superior
Stress Line
Should Go
To The
Spinal Canal
of T7
If Not,
Measure
The DLD
Angle
5
2
The DLD
Angle
RIGHT DLD
16 degrees
16
Cobb Angle
Put a
Horizontal
Line On the
Top Of The
Superior
Most Tilted
Vertebra
And On The
Bottom Of
The Inferior
Most Tilted
Vertebra
Cobb Angle
Draw A Line
Perpendicular
To The
Vertebral
Body Base
Line Superior
And Inferior
Cobb Angle
Draw A Line
Perpendicular
To The
Vertebral
Body Base
Line Superior
And Inferior
Cobb Angle
Measure The
Intersection
Of These
Lines
8
13
Cobb Angle
Measure The
Intersection
Of These
Lines
8
13
Cervical
Dorsal
Cobb Angle
Cervical
Dorsal
Cobb Angle
Left CD
Cobb
Angle
31
degrees
31
Cobb Angle
Be Sure To
Measure
The Cobb
Angle On
Both Sitting
X-ray and
The
Standing
Scoliosis
X-ray
Cobb Angle
Be Sure To
Measure
The Cobb
Angle On
Both Sitting
X-ray and
The
Standing
Scoliosis
X-ray 27
25
Cobb Angle
45
57
CLEAR X-Ray Analysis
2013
Dr. Dennis Woggon BSc, DC
X-rays from Dr. Nathan Wagner, DC
Edited by Dr. Kaila Hersh, DC

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