Radiological measurement of posterior tibial subluxation as a preoperative factor in choosing the type of implant in primary total knee arthroplasty.

Introduction: Total knee arthroplasty (TKA) is the most effective treatment of late osteoarthritis (OA) and is considered among the most successful surgical procedures in general. However, about 20% of patients remain dissatisfied. An important aspect of TKA is the proper choice of implant type - posterior stabilized (PS) or cruciate retaining (CR). Both have their indications for use based on intraoperative functional examination, but no objective radiological criteria have yet been developed. The aim of this study was to investigate the relationship between the posterior subluxation of the tibia on preoperative radiograms and implant type used. Material and methods: A series of 52 patients undergoing TKA were included in the study. All patients were over 50 years old, had clinically and radiologically confirmed primary OA of grade IV on the Kellgren-Lawrence scale and were undergoing a primary total knee replacement (TKR) with a PS or CR design. Preoperative lateral radiographs were analysed retrospectively. The tibial translation ratio was calculated as a percentage of subluxation in the length of the tibial plateau. Results: There were no significant differences between implant types in regard to investigated parameters. However, there was a significant difference between the groups CR and PS in regard to age (68.5 [60.0-72.0] vs. 72.5 [68.0-75.0], p = 0.006). Conclusions: This study revealed that preoperative tibial translation does not significantly correlate with the choice of implant type and so probably not with posterior cruciate ligament (PCL) function and efficiency either. Additionally, this study showed that PCL insufficiency is related to the age of the patients, because of the more frequent choice of the PS implant type for the surgery in older patients than in the case of the CR implant type.

Femoral head and acetabular necrosis combined with hip subluxation in people with HIV: a case report and literature review.

INTRODUCTION: HIV is widely prevalent in all regions of the world. The use of antiretroviral drugs has dramatically reduced the mortality rate of HIV-related diseases, but correspondingly increased the incidence of chronic complications in HIV-positive people. Related studies have found that the incidence of osteonecrosis of the femoral head is higher in HIV-positive people, but the co-occurrence of femoral head necrosis, acetabular necrosis and hip joint dislocation in HIV-positive patients is rare. METHODS: We report a 50-year-old man with a 15-month history of progressively worsening right hip pain with movement restriction. According to the CT findings of the other hospital, the patient was admitted to the hospital with femoral head necrosis. After the admission, the relevant X-ray, CT and MRI examinations showed that the right femoral head collapsed and deformed, with the surrounding bone sclerosis, bone fragments, loose body of the joint, right hip subluxation, acetabular marginal osteogeny, and local microcystic degeneration. The left femoral head was in good shape, and cystic degeneration can be seen under the articular surface. The patient was finally diagnosed with femoral head necrosis and acetabular necrosis combined with hip subluxation. RESULTS: The pain of the patient was significantly relieved after the operation, and the patient was discharged from the hospital one week after the start of treatment to continue rehabilitation training. During the follow-up one month after the operation, the self-reported pain disappeared completely, and the limitation of activity was significantly improved.

Long-term outcome of adult traumatic atlantoaxial rotatory fixation: a case series.

BACKGROUND: This case series presents five cases of adult atlantoaxial rotatory subluxation (AARS) following traumatic events, focusing on treatment strategies and long-term outcomes. CASE PRESENTATION: This paper includes four Iranian male patients and one Iranian female patient with ages ranging from 25 to 46 years old. Each case involved unique presentations and management approaches. Initial conservative treatments, including skull traction and orthoses, were attempted, but surgical intervention became necessary due to inadequate response. Surgical fixation significantly improved functional status and alleviated symptoms in all patients, leading to long-term relief. Radiological assessments demonstrated successful outcomes post-surgery. CONCLUSIONS: This study underscores the importance of considering both conservative and surgical options in managing adult atlantoaxial rotatory subluxation to achieve optimal outcomes.

Reliability and Validity of an Ultrasound-Derived Measure for Axial Patellofemoral Alignment.

Background: Axial extensor mechanism alignment is routinely assessed in patients with patellofemoral instability.Although many of these assessments are described using magnetic resonance imaging, it is plausible that ultrasound (US) imaging could be utilized to provide similar information in a more cost-effective and time-efficient manner. Purpose: To (1) describe and assess the reliability of a novel measure of extensor mechanism alignment of the patellofemoral joint using musculoskeletal US and (2) establish the construct validity of this measure through comparison of patients with and without patellar instability. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Patients with (n = 24; 14.2 ± 3.1 years; 83% female) and without (n = 26; 14.7 ± 2.8 years; 69% female) a clinical history of patellofemoral instability (PFI) participated. Extensor mechanism alignment was assessed bilaterally on US, measuring the distance between the midpoint of the patellar tendon to the lateral trochlear ridge (MPT-LTR). Interrater reliability of the measurements was assessed using the intraclass correlation coefficient (ICC), with a minimum of 1 week between measurements for test-retest reliability. Differences between limbs were assessed using paired-samples t tests, and between-group differences were compared using independent-samples t tests. Results: Patients with PFI demonstrated a significantly smaller MPT-LTR distance than healthy controls on both their involved (8.1 ± 3.6 vs 12.6 ± 2.6 mm) and uninvolved (8.9 ± 3.4 vs 12.9 ± 2.4 mm) limbs (P < .001 for both), indicating greater lateralization of the patellar tendon relative to the trochlea. There were no differences found between limbs for either patients with PFI (P = .26) or controls (P = .46). Interrater reliability was good (ICC = 0.785; 95% confidence interval [CI], 0.579-0.890), and test-retest reliability (n = 8) was excellent (ICC = 0.958; 95% CI, 0.790-0.992). Conclusion: The US-based MPT-LTR distance demonstrated good-to-excellent reliability. When compared with controls, the MPT-LTR distance was smaller in patients with PFI, indicating greater lateralization of the extensor mechanism.

Improvement of Posterior Cruciate Ligament Buckling and Anterior Tibial Subluxation by Anterior Scar Removal of the Posterior Cruciate Ligament: A Case Report.

Posterior cruciate ligament (PCL) buckling and anterior tibial subluxation are observed in patients with insufficient anterior cruciate ligament (ACL). Here, we report the case of a patient after ACL reconstruction in whom these symptoms were improved by anterior scar resection of buckled PCL. The patient was a 46-year-old man. Six years ago, he underwent ACL reconstruction; however, his condition was not satisfactory. Magnetic resonance imaging (MRI) showed intercondylar impingement of the graft, anterior tibial subluxation, and PCL buckling. Intercondylar notchplasty and resection of the anterior scar of PCL were performed arthroscopically. Postoperative MRI showed improvement in PCL buckling and anterior tibial subluxation. His symptoms improved, and he was able to jog one year after surgery.  Anterior scar resection of PCL may improve PCL buckling and anterior tibial subluxation after ACL reconstruction.

Intraocular Pressure-Lowering Effect of Intraocular Lens Refixation in Patients with Elevated Intraocular Pressure Due to Intraocular Lens Subluxation.

Background and Objectives: To evaluate the surgical outcomes of intraocular lens (IOL) refixation with vitrectomy in patients with elevated intraocular pressure (IOP) due to IOL subluxation. Materials and Methods: Patients with elevated IOP due to IOL subluxation who had undergone IOL refixation with vitrectomy between 1 June 2013 and 31 December 2023 were retrospectively evaluated. The primary outcome measure was surgical success or failure. Surgical success was defined as a reduction of ≥20% in the preoperative IOP or IOP ≤ 21 mmHg (criterion A), IOP ≤ 18 mmHg (criterion B), or IOP ≤ 15 mmHg (criterion C). Reoperation, loss of light perception, and hypotony were considered as surgical failure. The IOP, number of glaucoma medications used, postoperative complications, and visual acuity were evaluated as the secondary outcomes. The surgical outcomes were compared between the glaucoma and ocular hypertension (OH) groups. Results: At 12 months postoperatively, the probability of success was 72.5%, 54.1%, and 28.4% using criterion A, B, and C, respectively, and the mean IOP and mean number of glaucoma medications used had decreased significantly (p < 0.01 and p = 0.03, respectively). Furthermore, the cumulative success rate was significantly higher in the OH group than in the glaucoma (100% vs. 47.4%; p < 0.01) when using criterion A. Additional glaucoma surgery was required only in the glaucoma group. Conclusions: IOL refixation surgery significantly decreases the IOP and number of glaucoma medications required in patients with elevated IOP due to IOL subluxation. Thus, IOL refixation surgery alone without glaucoma surgery might be effective as the primary procedure in such patients.

Surgical stabilisation of a traumatic cervical subluxation in a cat.

Case summary: A 2-year-old spayed female domestic shorthair cat presented with tetraparesis after being involved in a road traffic accident. Survey spine radiographs revealed a C2-C3 cervical subluxation, which was confirmed by a CT scan. Surgical stabilisation was performed using screws and polymethyl methacrylate (PMMA) via a ventral approach. A postoperative CT scan demonstrated correct implant positioning and good reduction of the subluxation. After surgery, the cat rapidly recovered to a neurologically normal status. Relevance and novel information: Trauma-induced cervical subluxation is an uncommon occurrence in cats but should be considered in the differential diagnosis. This report describes the surgical management of a C2-C3 cervical subluxation in a cat using screws and PMMA. This is the first case report of a surgically treated subaxial cervical subluxation in a cat.

Short-term outcomes of implanting a retropupillary iris-claw intraocular lens in patients with lens and intraocular lens drops.

Lens drop and intraocular lens (IOL) drop can occur after cataract or phacoemulsification surgery, where the IOL is dislocated from the capsular bag into the vitreous cavity. The aim of this study was to investigate the short-term outcomes of implanting a retropupillary iris-claw in patients with IOL drop and lens drop after phacoemulsification. A cross-sectional study was conducted at Santosa Hospital, Bandung, West Java, Indonesia, from January 2020 to December 2023. Patients were divided into two groups: IOL drop and lens drop groups. Total sampling was used, involving 51 patients in the present study, with 27 patients in the IOL drop group and 24 patients in the lens drop group. Data collected included age, sex, eye laterality, the onset of IOL drop or lens drop, intraocular pressure (IOP), uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), record of astigmatism change preoperative and postoperative, and postoperative pars plana vitrectomy (PPV) complications. Our data indicated that the UDVA significantly improved in both IOL drop and lens drop groups after PPV surgery (p<0.001). However, there were no significant changes in IOP or astigmatism following the surgery in either group. Over one month, both groups showed improved UDVA, decreased IOP, and changes in astigmatism, with no significant differences between groups. Similarly, there was no significant difference in CDVA between IOL drop and lens drop groups. Only four complications were recorded in the present study. Comparing IOL drop and lens drop groups, only an increase in IOP showed a significant difference (p=0.018). Corneal edema, IOL decentration, and pupil ovalization were not significantly different. In conclusion, retropupillary iris-claw IOL implantation is safe and effective for aphakic patients with complications from phacoemulsification, regardless of whether it is lens drop or IOL drop.

Translation, Cross-Cultural Adaptation, and Validation of the Italian Version of the Shoulder Instability-Return to Sport After Injury (SI-RSI) Scale.

OBJECTIVE: To culturally adapt and validate the Italian version of the Shoulder Instability-Return to Sport after Injury (SI-RSI-I) scale. METHODS: The SI-RSI-I was developed by adapting the Anterior Cruciate Ligament-Return to Sport Index-Italian version and replacing the term "knee" with "shoulder." Subsequently, it underwent validation following COSMIN recommendations. The study involved athletic participants who experienced SI. They completed the SI-RSI-I together with other measurement instruments: Western Ontario Shoulder Instability Index, Kerlan-Jobe Orthopedic Clinic Score, EuroQol-5D-5L, and Numeric Pain Rating Scale. The following psychometric properties were investigated: structural validity, internal consistency, test-retest reliability, measurement error, and construct validity. RESULTS: The study included 101 participants (age mean [SD] 28.5 [7.4] y; 83 males, 18 females). The SI-RSI-I showed a single-factor structure, excellent internal consistency (α = .935), and excellent test-retest reliability (ICC = .926; 95% CI, .853-.964). The standard error of measurement was 6.1 points, and the minimal detectable change was 17.0 points. Furthermore, SI-RSI-I demonstrated moderate to strong correlations with all reference scales, confirming 8 out of 9 (88.0%) hypotheses, thus establishing satisfactory construct validity. CONCLUSION: The SI-RSI-I has demonstrated robust internal consistency, reliability, validity, and feasibility as a valuable scale for assessing psychological readiness to return to sport in Italian athletes with SI.

The Lycra arm sleeve for treatment of glenohumeral subluxation in people with sub-acute stroke: a randomized controlled (RC) feasibility study.

BACKGROUND: A Lycra arm sleeve has the potential to reduce glenohumeral subluxation (GHS) in people with stroke (PwS). Aims were (1) to provide feasibility data to inform a future fully powered randomized controlled trial, (2) to understand whether patients would be willing to be randomized, (3) to measure changes in GHS at 3 months after wearing the sleeve when compared to not wearing the sleeve. METHOD: PwS ≥18 years with ≤3/5 shoulder abduction strength and able to give informed consent were recruited. The feasibility data on recruitment, screening, and retention rate at 12 weeks were collected. Participants were asked if they would be happy to be randomized into one of the two groups. The immediate group received the Lycra sleeve on recruitment and wore for up to 10 hours/day for 3 months. The delayed group received the sleeve after follow-up assessment at 3 months. GHS was assessed using diagnostic ultrasound method. RESULTS: Over one year, 257 patients were screened, 34 patients were eligible, and 31 (91%) were recruited. Retention at 3 months was 27 (87%). Of those eligible, all found randomization to be acceptable. In the immediate group, GHS showed reduction from 2.6 ± 0.7 cm (95% CI 2.0-3.1 cm) at baseline to 2.2 ± 0.4 cm (CI 2.0-2.5 cm) at 12 weeks. In the delayed group, mean GHS remained unchanged over 3 months period (2.3 ± 0.5 cm, CI 1.9-2.7 cm). CONCLUSION: Recruitment was harder than anticipated, but there was high retention demonstrating feasible methodology. There is some indication of a clinical effect of Lycra sleeve on GHS early after stroke.

Short-term intervention effect analysis of neuromuscular joint facilitation in patients who experienced stroke with shoulder subluxation: a clinical randomized controlled trial.

[Purpose] Shoulder subluxation is a common complication of acute stroke that affects clinical rehabilitation training and hinders the recovery of upper limb motor function. This study explored the short-term interventional effects of neuromuscular joint facilitation in patients who experienced stroke with shoulder subluxation. [Participants and Methods] We recruited 36 patients who experienced stroke with shoulder subluxation. All patients were randomly divided into two groups: the neuromuscular joint facilitation group (n=18) and the control group (n=18). The control group underwent routine rehabilitation treatment. The intervention in the neuromuscular joint facilitation group involved neuromuscular joint facilitation of the shoulder joint in four modes based on conventional rehabilitation treatment. Four different interventions were administered. The thickness of the supraspinatus muscle and the acromion-greater tuberosity distance were measured using ultrasound to observe the curative effect. [Results] In neuromuscular joint facilitation group, the thickness of supraspinatus muscle, acromion-greater tuberosity distance and acromion-greater tuberosity distance difference were significantly different before and after intervention. In the control group, there were no significant difference before and after intervention. [Conclusion] Neuromuscular joint facilitation intervention improved the thickness of the supraspinatus muscle, shortened the distance between the acromion and the greater tubercle, and improved shoulder subluxation in patients who experienced stroke.

Complications and Revisions for Adduction Arytenopexy, Medialization Laryngoplasty, and Cricothyroid Subluxation over 19 Years.

OBJECTIVE: To report the long-term data of the Triple procedure (medialization laryngoplasty, adduction arytenopexy, and cricothyroid subluxation) regarding complications and revisions in a large cohort of patients. STUDY DESIGN: Retrospective case series. METHODS: This study included patients who underwent ≥1 components of the Triple procedure between January 2000 and July 2019. Demographic data, etiology of paralysis, duration of follow-up, complications, revision surgeries, and touch-up injections were noted from retrospective chart review. RESULTS: Of the 222 patients who underwent ≥1 of the Triple procedure components, 86 underwent medialization laryngoplasty alone and were excluded from the study. The remaining 136 underwent ≥1 components of the Triple procedure other than medialization laryngoplasty alone. The overall surgical complication rate was 7.3% (10/136) and no intraoperative complications were noted. Of the 10 complications, four were implant extrusions, four were hematoma, and two were rupture of the arytenoid fixation suture. In all, 20 of the 136 cases subsequently required revision surgery (14.7%) at a mean of 57.3months after the initial surgery. CONCLUSION: The present findings show that the Triple procedure, or its subcomponents, can be performed with few complications and acceptable revision rates.

Assessing the Impact of Undiagnosed C1‒C2 Rotatory Subluxation in the Conservative Treatment of Odontoid Fractures.

BACKGROUND: The presence of clear high-grade rotatory subluxation, in addition to an odontoid fracture, is a definite indication for surgery. However, the presence of a more subtle subluxation-Grades 1, 2, or 3-can often be overlooked, and as a result, prognostic associations with second cervical vertebrae (C2) fractures are rare. In light of this, we assessed the failure rate of conservative management in patients with both an odontoid fracture and a concurrent first and second cervical vertebrae (C1‒C2) rotatory subluxation. METHODS: A retrospective, cohort (nested case-control) study of patients with odontoid C2 fractures with or without C1‒C2 joint rotatory subluxation was performed. Patients were classified according to the type of odontoid fracture (Alonzo classification) and the presence of C1‒C2 subluxation (Feldings classification). The number of patients who were initially treated with collars and then underwent surgery due to conservative treatment failure was analyzed. We performed logistic regression analysis to determine the odds ratio and generate a receiver operating characteristic curve of the association between the degree of subluxation and failure of conservative treatment. RESULTS: One hundred fifteen patients with C2 fractures that were treated conservatively with or without C1‒C2 rotatory subluxation. Of all 115 patients, 29 (25%) experienced treatment failure and required surgery. A statistically significant correlation was found between treatment failure and the presence of rotatory subluxation (odds ratio 10), compared with patients without C1‒C2 subluxation. CONCLUSIONS: In our series, C2 Alonzo fractures with a C1‒C2 rotatory subluxation had a 10-fold increased risk of secondary displacement and subsequent need for surgery. Further research on this association could improve the management of these conditions.

Arthroscopic selective approach to dynamic posterior shoulder instability: long-term follow-up insights.

BACKGROUND: The objective of this study is to evaluate the outcomes of arthroscopic capsulolabral repair in patients with structural dynamic posterior instability (Moroder classification B2), analyzing factors associated with inferior clinical outcomes or recurrence. The primary hypothesis is that this surgical approach in patients without static structural changes such as excessive glenoid retroversion or dysplastic glenoids will result in satisfactory clinical outcomes and low failure rates. METHODS: We conducted observational retrospective analysis in patients diagnosed with posterior structural dynamic instability who underwent arthroscopic capsulolabral repair. Demographic, clinical, and radiologic characteristics were registered, as well as patient-reported outcomes, satisfaction, complications, and failure, with a minimum 2-year follow-up. The association between these outcomes and preoperative factors was investigated. RESULTS: 21 patients were included, with an average age of 38.1 years (range: 27-51 years) and a mean follow-up of 68.7 months (range: 24-127 months). At the final follow-up, the degree of instability was 0 in 19 (90.5%) patients. The overall outcome assessment demonstrated a mean Subjective Shoulder Value score of 82.3 (±15.2), a mean Western Ontario Shoulder Instability score of 460.1 (±471), and a mean Rowe score of 91.5 (±13). Furthermore, a significant portion of patients returned to sport: 71.4% at any level and 57.1% at the previous level, and 71.4% reported satisfaction with treatment, whereas 5 (23.8%) patients had criteria for failure. CONCLUSION: Arthroscopic capsulolabral repair in selected patients with type B2 posterior shoulder instability without static posterior findings yielded satisfactory clinical outcomes and low failure rates.

Early Occipitocervical Fusion Surgery in a Rare Clinical Encounter of Non-traumatic Atlantooccipital Subluxation (AOS) in Down Syndrome (Trisomy 21).

Subluxation of the atlantooccipital joint in patients with underlying Down syndrome is an extremely rare orthopedic condition. The condition can pose life-threatening risks if not promptly diagnosed and treated in the early stage. Yet, there have been documented cases of survival following atlantooccipital subluxation or dislocation. Atlantooccipital subluxation (AOS) is usually identified during screening in children with Down syndrome for atlantoaxial subluxation (AAS). Therefore, careful evaluation of the atlantooccipital joint from radiographs is also essential. It is crucial to emphasize the clinical significance of AOS. Here the authors present the case of a fifteen-year-old girl with underlying Down syndrome (trisomy 21) who survived a sudden onset of non-traumatic atlantooccipital subluxation with spinal cord compression. There are only a few cases were reported in patients with Down syndrome (trisomy 21) and only two cases with surgically treated atlantooccipital (C0C1) subluxation have been reported. This case is of particular interest as it represents the first reported case of atlantooccipital (C0C1) subluxation with spinal cord compression in Down syndrome that underwent occipitocervical fusion surgery during the acute presentation, resulting in significant neurological recovery. Her neurology symptoms and physical functions showed remarkable improvement post-surgery, and she is doing well at the one-year follow-up in the clinic. Early surgery during acute presentation in this case resulted in good surgical outcomes and improved patient quality of life.

The Matrix Approach to Patellar Instability.

Patellar instability is a challenging orthopedic condition affecting both pediatric and adult populations. The diagnosis and treatment of this condition present challenges for surgeons because of the multitude of classifications and treatment options available in the literature, leading to potential confusion in treatment strategies. Nonoperative treatments often prove ineffective, with reported recurrence rates nearing. Consequently, numerous surgical interventions have been developed in pursuit of improved outcomes. However, the results of these early interventions have not been universally successful, resulting in over 100 surgical interventions being recommended for patellofemoral instability, and none of which have achieved universal success. This hesitancy among surgeons to recommend surgery can leave patients inadequately treated. This article aims to share our matrix approach to patellar instability, developed over the past decade. By providing insights into the condition, we hope to stimulate interest among aspiring surgeons and facilitate a comprehensive understanding of the diagnosis and management of patellofemoral instability.

A New Case Report of Traboulsi Syndrome: A Literature Review and Insights Into Genotype-Phenotype Correlations.

Traboulsi syndrome is a rare genetic disorder characterized by facial dysmorphism, lens subluxation, anterior segment anomalies, and spontaneous filtering blebs. The syndrome is due to mutations in the ASPH gene, which plays a crucial role in the development and maintenance of the lens. This case report describes the clinical and genetic findings in a Mexican male with Traboulsi syndrome, highlighting the identification of a novel ASPH variant. A 21-year-old male presented with trauma to the right eye while playing soccer. He had a history of lens subluxation and dysmorphic facial features. Ophthalmic examination revealed right eye lens subluxation into the anterior chamber (with signs of a previous episode of acute angle closure) and left eye posterior and inferior lens subluxation with sectorial iris atrophy. Genetic analysis identified a pathogenic ASPH variant (NM_004318.3:c.1892G>A, p.Trp631*) and a novel likely pathogenic variant (deletion of exons 20-21), confirming Traboulsi syndrome. This is the first instance of Traboulsi syndrome in the Mexican population. The absence of spontaneous filtering blebs in this patient supports previous reports of the wide phenotypic variability that could be related to the type of mutation. This novel ASPH variant expands the known genetic heterogeneity of Traboulsi syndrome.

Biomechanics and Pathoanatomy of Posterior Shoulder Instability.

Posterior glenohumeral instability represents a wide spectrum of pathoanatomic processes. A key consideration is the interplay between the posterior capsulolabral complex and the osseous anatomy of the glenoid and humeral head. Stability is dependent upon both the presence of soft tissue pathology (eg, tears to the posteroinferior labrum or posterior band of the inferior glenohumeral ligament, glenoid bone loss, reverse Hill Sachs lesions, and pathologic glenoid retroversion or dysplasia) and dynamic stabilizing forces. This review highlights unique pathoanatomic features of posterior shoulder instability and associated biomechanics that may exist in patients with posterior glenohumeral instability.

An investigation into the chiropractic practice and communication of routine, repetitive radiographic imaging for the location of postural misalignments.

Many chiropractors use radiological imaging, particularly X-rays, to locate and diagnose the cause of their patients' pain. However, this approach is fundamentally flawed because X-rays provide anatomical information but not functional insights. Pain, tissue damage, and injury do not always correlate directly with X-ray appearances. Given the high incidence of abnormalities found in X-rays of asymptomatic patients, the diagnostic validity of X-rays can be questioned, especially when used in isolation of the patient's history and/or a proper clinical assessment. One may posit that their application promotes overdiagnosis, and unvalidated treatment of X-ray findings (such as changes in postural curvature), which may mislead patients into believing these changes are directly responsible for their pain. A substantial amount of research has shown that there is no association between pain and reversed cervical curves. X-ray accuracy can vary due to several factors, including patient positioning, physical and morphological changes, interreliability among doctors, and other influences such as stress, pain, and emotional state. Over the past two decades, medical boards and health associations worldwide have made significant efforts to communicate better when imaging is necessary, focusing on reducing radiographic imaging. This review describes concerns about the frequent, almost routine use of spinal X-rays in primary care for spine-related pain in the absence of red-flag clinical signs.