Mandibular slope: a reproducible and simple measure of horizontal gaze
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Mandibular slope: a reproducible and simple measure of horizontal gaze Stephen George1 · Matthew Spiegel2 · Themistocles Protopsaltis2 · Aaron J. Buckland2 · Jaime A. Gomez3 · Subaraman Ramchandran1 · Renaud Lafage4 · Virginie Lafage4 · Thomas Errico1 · Baron Lonner5 Received: 15 November 2019 / Accepted: 11 May 2020 © Scoliosis Research Society 2020
Abstract Study design This study is a single-center retrospective radiographic review. Objectives The objective of this study is to evaluate a novel measurement parameter, mandibular slope (MS), as a measure of horizontal gaze. Introduction Assessment of sagittal spinal alignment is essential in the evaluation of spinal deformity patients. Ability to achieve a horizontal gaze, a parameter of sagittal alignment, is needed for the performance of daily activities. Standard measures of horizontal gaze, including the gold-standard chin–brow to vertical angle (CBVA) and the surrogate measures McGregor’s line (McGS) and Chamberlain’s line (CS), require high-quality imaging, precise head positioning, and reliance on difficult to view visual landmarks. A novel measurement parameter, MS, utilizing the caudal margin of the mandible on standard lateral spine radiographs is proposed. Methods 90 radiographs from spine deformity patients with or without spinal implants from a single center were evaluated. Three spine surgery fellows independently measured CBVA, McGS, CS, and MS at two timepoints at least one week apart to assess accuracy and reliability. MS was measured as the angle created by the inferior edge of the mandibular body and the horizontal. Formulas for calculating CBVA based on the above parameters were derived and compared to the actual CBVA. Results Mean age was 49.7 years, 76 females and 14 males. CBVA correlated with CS, McGS, and MS, r = 0.85, 0.81, and 0.80, respectively (p
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