Segmental lumbar lordosis

Manual versus computer-assisted measurement using seven different techniques

Thomas C. Schuler, Brian R. Subach, Charles L. Branch, Kevin Foley, J. Kenneth Burkus

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Objectives: Obliteration of end-plate landmarks by interbody fusion has made the traditional measurement of segmental lumbar lordosis nearly impossible. Because the L4-L5 and L5-S1 levels are most likely to be subjected to fusion procedures or arthroplasty and contribute to more than half of normal lumbar lordosis, it is crucial to identify a reproducible and accurate means of measuring segmental lordosis at these levels. Methods: Twelve spinal surgeons measured lordosis at L4-L5 and L5-S1 on 10 separate radiographs using three techniques for L4-L5 and four techniques for L5-S1. With use of identical radiographs, measurements first were made using a manual method and then were repeated with a computer-assisted method. Measurements were analyzed for both intraobserver and interobserver error. Results: The individual data demonstrated an intraobserver variance of 9.56 and a standard deviation of 3.092 for computerized measurements compared with 7.742 and 2.782 for manual measurements. The interobserver variance was 4.107 with a standard deviation of 2.027 for the computerized group compared with 4.221 and 2.055 for manual measurements. When analyzed as a group to evaluate interobserver error, the pooled data yielded variance of 19.235 for the computerized group and 19.117 for the manual measurements. Conclusions: Variance calculations identified the Cobb technique and the posterior vertebral body technique as the least variable measurement techniques for the L4-L5 and L5-S1 levels, respectively; however, there was no statistical significance. In direct comparison, the manual and computer-assisted techniques were found to be statistically equivalent with similar degrees of variance. We believe that the anterior vertebral technique, which did not demonstrate a significant difference from other techniques, will prove to be the most reliable method of assessing segmental lumbar lordosis in patients before surgery, after interbody fusion, and after motion-sparing disc arthroplasty.

Original languageEnglish (US)
Pages (from-to)372-379
Number of pages8
JournalJournal of Spinal Disorders and Techniques
Volume17
Issue number5
DOIs
StatePublished - Oct 1 2004

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Lordosis
Arthroplasty

All Science Journal Classification (ASJC) codes

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Segmental lumbar lordosis : Manual versus computer-assisted measurement using seven different techniques. / Schuler, Thomas C.; Subach, Brian R.; Branch, Charles L.; Foley, Kevin; Burkus, J. Kenneth.

In: Journal of Spinal Disorders and Techniques, Vol. 17, No. 5, 01.10.2004, p. 372-379.

Research output: Contribution to journalArticle

Schuler, Thomas C. ; Subach, Brian R. ; Branch, Charles L. ; Foley, Kevin ; Burkus, J. Kenneth. / Segmental lumbar lordosis : Manual versus computer-assisted measurement using seven different techniques. In: Journal of Spinal Disorders and Techniques. 2004 ; Vol. 17, No. 5. pp. 372-379.
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