Intra- and inter-observer reliability of determining radiographic sagittal parameters of the spine and pelvis using a manual and a computer-assisted methods.

Sagittal imbalance is a significant factor in determining clinical treatment outcomes in patients with deformity. Measurement of sagittal alignment using the traditional Cobb technique is frequently hampered by difficulty in visualizing landmarks. This report compares traditional manual measurement...

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Published in:European Spine Journal Vol. 17; no. 10; pp. 1373 - 1380
Main Authors: Dimar JR 2nd, Carreon LY, Labelle H, Djurasovic M, Weidenbaum M, Brown C, Roussouly P, Dimar, John R 2nd, Carreon, Leah Y, Labelle, Hubert, Djurasovic, Mladen, Weidenbaum, Mark, Brown, Courtney, Roussouly, Pierre
Format: research Journal Article
Published: Springer Nature Oct2008
Online Access:View this record in EBSCOhost
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      dt: Oct2008
      vid: 17
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      pub: Springer Nature
      place: New York, New York
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        10.1007/s00586-008-0755-1
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        atl: Intra- and inter-observer reliability of determining radiographic sagittal parameters of the spine and pelvis using a manual and a computer-assisted methods.
      aug:
        au:
          Dimar JR 2nd
          Carreon LY
          Labelle H
          Djurasovic M
          Weidenbaum M
          Brown C
          Roussouly P
          Dimar, John R 2nd
          Carreon, Leah Y
          Labelle, Hubert
          Djurasovic, Mladen
          Weidenbaum, Mark
          Brown, Courtney
          Roussouly, Pierre
        affil: Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202, USA
      sug:
        subj:
          Pelvis Radiography
          Radiographic Image Interpretation, Computer-Assisted Methods
          Spinal Curvatures Radiography
          Spine Radiography
          Adult
          Observer Bias
          Reproducibility of Results
          Human
          Adult: 19-44 years
      ab: Sagittal imbalance is a significant factor in determining clinical treatment outcomes in patients with deformity. Measurement of sagittal alignment using the traditional Cobb technique is frequently hampered by difficulty in visualizing landmarks. This report compares traditional manual measurement techniques to a computer-assisted sagittal plane measurement program which uses a radius arc methodology. The intra and inter-observer reliability of the computer program has been shown to be 0.92-0.99. Twenty-nine lateral 90 cm radiographs were measured by a computer program for an array of sagittal plane measurements. Ten experienced orthopedic spine surgeons manually measured the same parameters twice, at least 48 h apart, using a digital caliper and a standardized radiographic manual. Intraclass correlations were used to determine intra- and interobserver reliability between different manual measures and between manual measures and computer assisted-measures. The inter-observer reliability between manual measures was poor, ranging from -0.02 to 0.64 for the different sagittal measures. The intra-observer reliability in manual measures was better ranging from 0.40 to 0.93. Comparing manual to computer-assisted measures, the ICC ranged from 0.07 to 0.75. Surgeons agreed more often with each other than with the machine when measuring the lumbar curve, the thoracic curve, and the spino-sacral angle. The reliability of the computer program is significantly higher for all measures except for lumbar lordosis. A computer-assisted program produces a reliable measurement of the sagittal profile of the spine by eliminating the need for distinctly visible endplates. The use of a radial arc methodology allows for infinite data points to be used along the spine to determine sagittal measurements. The integration of this technique with digital radiography's ability to adjust image contrast and brightness will enable the superior identification of key anatomical parameters normally not available for measurement on traditional radiographs, improving the consistency of sagittal measurement.
      pubtype: Academic Journal
      doctype:
        research
        Journal Article
      ougenre: Article
    language: English
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