title: Intermittent Feet Dorsiflexion as a Simple Trick to Improve Cervical Fluoroscopic Visualization.
abstract: BACKGROUND
  Anterior cervical surgery is routinely performed using fluoroscopy. Visualizing the lower cervical levels can be challenging, particularly in obese, muscular, and broad-shouldered patients. We found that grabbing both feet of the patient at the level of the metatarsals and cranially pushing the feet, creating dorsiflexion at the ankle joints, seems to increase the number of fluoroscopically visualized cervical levels. We aimed to measure the average change in fluoroscopically visualized levels when performing this maneuver.
  
  
  METHODS
  In 10 consecutive patients undergoing an anterior cervical discectomy and fusion procedure, we counted the number of fluoroscopically visualized cervical levels. Visible cervical levels in lateral fluoroscopic cervical images that were taken with and without the execution of the aforementioned maneuver were counted by 2 blinded observers.
  
  
  RESULTS
  Performing this maneuver added on average almost 1 vertebral body height to the fluoroscopic image. The additional number of fluoroscopically visible cervical levels was significantly higher in patients <50 years old but was not affected by sex or body mass index.
  
  
  CONCLUSIONS
  We propose a simple, convenient, and effective technique to increase the number of visualized cervical levels on lateral cervical fluoroscopy. This maneuver may have some advantages compared with other commonly used techniques.
authors.affiliation: Department of Neurosurgery, Ziekenhuis Oost-Limburg, Genk, Belgium; Department of Neurosurgery, University Hospitals Leuven, KU Leuven, Leuven, Belgium. Electronic address: philippe.devloo@gmail.com.
authors.forename: Philippe
authors.initials: P
authors.lastname: De Vloo
authors.affiliation: Department of Neurosurgery, Ziekenhuis Oost-Limburg, Genk, Belgium.
authors.forename: Belinda
authors.initials: B
authors.lastname: Schrooten
authors.affiliation: Department of Neurosurgery, Ziekenhuis Oost-Limburg, Genk, Belgium.
authors.forename: Thomas
authors.initials: T
authors.lastname: Daenekindt
authors.affiliation: Department of Neurosurgery, Ziekenhuis Oost-Limburg, Genk, Belgium.
authors.forename: Jens
authors.initials: J
authors.lastname: Deckers
authors.affiliation: Department of Neurosurgery, Ziekenhuis Oost-Limburg, Genk, Belgium.
authors.forename: Diedrik
authors.initials: D
authors.lastname: Peuskens
authors.affiliation: Department of Neurosurgery, Ziekenhuis Oost-Limburg, Genk, Belgium.
authors.forename: Koen
authors.initials: K
authors.lastname: Engelborghs
authors.affiliation: Department of Neurosurgery, Ziekenhuis Oost-Limburg, Genk, Belgium; Department of Morphology, Faculty of Medicine, University of Hasselt, Hasselt, Belgium.
authors.forename: Frank
authors.initials: F
authors.lastname: Weyns
authors.affiliation: Department of Neurosurgery, Ziekenhuis Oost-Limburg, Genk, Belgium.
authors.forename: Jan
authors.initials: J
authors.lastname: Wuyts
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000601:surgery*; D017586:Diskectomy / Q000379:methods*; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D005528:Foot; D006801:Humans; D008297:Male; D056888:Patient Positioning / Q000379:methods*; D011856:Radiographic Image Enhancement / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D025321:Surgery, Computer-Assisted / Q000379:methods*
keywords: Anterior cervical discectomy; Cervical spine; Feet dorsiflexion; Fluoroscopy; Visualization; Wrong level