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Comparison of sagittal values between lateral decubitus plain radiography and supine computed tomography in thoracolumbar fractures: a greater degree of kyphosis is observed in plain radiography than CT

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Objective

Radiologic parameters are important factors for planning the treatment for thoracolumbar fracture. However, we noted that measurements of the degree of kyphosis by lateral decubitus plain radiography were greater than supine CT. The cause of this discrepancy is unclear.

Methods

We retrospectively reviewed the plain radiographs and CT scans of 90 patients with thoracolumbar fractures (fracture group). We measured the segmental sagittal angle (SSA) on lateral decubitus plain radiographs and in the median sagittal plane on CT scans obtained in the supine position. The method agreement (plain radiography versus CT) was determined by utilizing Bland–Altman plots. For the purpose of comparison, the same analyses were performed in a group of age and sex-matched controls (normal group). After establishing the method disagreement in the fracture group, the factors that contributed to the difference in the SSA between plain radiography and CT, as well as their threshold values, were determined.

Results

On Bland–Altman plots for the fracture group, the mean difference was 4.53° [95% confidence interval (CI) − 4.87° to 13.93°]. For the normal group, the mean difference was − 0.64° (95% CI − 5.87° to 4.58°). On univariate analysis, male sex, thoracolumbar level, and SSA(X) were significant factors associated with ∆SSA (P = 0.03, 0.002, and 0.000, respectively). Multivariable regression analysis showed that SSA(X) was the only significant factor. Receiver operating characteristic curve analysis indicated that the optimal threshold of SSA(X) was 17° with a sensitivity of 78% and a specificity of 75% (area under curve: 0.752).

Conclusions

The mean SSA determined on lateral decubitus plain radiographs indicated significantly more kyphosis than that determined on CT images obtained in supine position. When the SSA on plain radiography is more than 17°, there might be a significant discrepancy between the two imaging modalities. This discrepancy seems to be mainly attributable to the difference in patient positioning (lateral decubitus position for plain radiography versus supine position for CT imaging).

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References

  1. el-Khoury GY, Kathol MH, Daniel WW (1995) Imaging of acute injuries of the cervical spine: value of plain radiography, CT, and MR imaging. Am J Roentgenol 164:43–50. https://doi.org/10.2214/ajr.164.1.7998567

    Article  CAS  Google Scholar 

  2. Stewart BG, Rhea JT, Sheridan RL, Novelline RA (2002) Is the screening portable pelvis film clinically useful in multiple trauma patients who will be examined by abdominopelvic CT? Experience with 397 patients. Emerg Radiol 9:266–271. https://doi.org/10.1007/s10140-002-0232-9

    Article  PubMed  Google Scholar 

  3. McCulloch PT, France J, Jones DL, Krantz W, Nguyen T-P, Chambers C et al (2005) Helical computed tomography alone compared with plain radiographs with adjunct computed tomography to evaluate the cervical spine after high-energy trauma. J Bone Jt Surg Am 87:2388–2394. https://doi.org/10.2106/JBJS.E.00208

    Article  Google Scholar 

  4. Berry GE, Adams S, Harris MB, Boles CA, McKernan MG, Collinson F et al (2005) Are plain radiographs of the spine necessary during evaluation after blunt trauma? Accuracy of screening torso computed tomography in thoracic/lumbar spine fracture diagnosis. J Trauma 59:1410–1413 (discussion 1413)

    Article  PubMed  Google Scholar 

  5. Hauser CJ, Visvikis G, Hinrichs C, Eber CD, Cho K, Lavery RF et al (2003) Prospective validation of computed tomographic screening of the thoracolumbar spine in trauma. J Trauma 55:228–234. https://doi.org/10.1097/01.TA.0000076622.19246.CF (discussion 234–235)

    Article  PubMed  Google Scholar 

  6. Ballock RT, Mackersie R, Abitbol JJ, Cervilla V, Resnick D, Garfin SR (1992) Can burst fractures be predicted from plain radiographs? J Bone Jt Surg Br 74:147–150

    Article  CAS  Google Scholar 

  7. Campbell SE, Phillips CD, Dubovsky E, Cail WS, Omary RA (1995) The value of CT in determining potential instability of simple wedge-compression fractures of the lumbar spine. Am J Neuroradiol 16:1385–1392

    PubMed  CAS  Google Scholar 

  8. Dai L-Y, Wang X-Y, Jiang L-S, Jiang S-D, Xu H-Z (2008) Plain radiography versus computed tomography scans in the diagnosis and management of thoracolumbar burst fractures. Spine 33:E548–E552

    Article  PubMed  Google Scholar 

  9. Abdel MP, Bodemer WS, Anderson PA (2012) Supine thoracolumbar sagittal spine alignment: comparing computerized tomography and plain radiographs. Spine 37:340–345. https://doi.org/10.1097/BRS.0b013e31821946d1

    Article  PubMed  Google Scholar 

  10. Epstein O, Ludwig S, Gelb D, Poelstra K, O’Brien J (2009) Comparison of computed tomography and plain radiography in assessing traumatic spinal deformity. J Spinal Disord Tech 22:197–201

    Article  PubMed  Google Scholar 

  11. Vaccaro AR, Oner C, Kepler CK, Dvorak M, Schnake K, Bellabarba C et al (2013) AOSpine thoracolumbar spine injury classification system: fracture description, neurological status and key modifiers. Spine 38:2028–2037. https://doi.org/10.1097/BRS.0b013e3182a8a381

    Article  PubMed  Google Scholar 

  12. Kuklo TR, Polly DW, Owens BD, Zeidman SM, Chang AS, Klemme WR (2001) Measurement of thoracic and lumbar fracture kyphosis: evaluation of intraobserver, interobserver, and technique variability. Spine 26:61–65 (discussion 66)

    Article  PubMed  CAS  Google Scholar 

  13. Shrout PE, Fleiss JL (1979) Intraclass correlations: uses in assessing rater reliability. Psychol Bull 86:420–428

    Article  PubMed  CAS  Google Scholar 

  14. Adam CJ, Izatt MT, Harvey JR, Askin GN (2005) Variability in Cobb angle measurements using reformatted computerized tomography scans. Spine 30:1664–1669

    Article  PubMed  Google Scholar 

  15. Farcy JP, Weidenbaum M, Glassman SD (1990) Sagittal index in management of thoracolumbar burst fractures. Spine 15:958–965

    Article  PubMed  CAS  Google Scholar 

  16. Malcolm BW, Bradford DS, Winter RB, Chou SN (1981) Post-traumatic kyphosis. A review of forty-eight surgically treated patients. J Bone Jt Surg Am 63:891–899

    Article  CAS  Google Scholar 

  17. McAfee PC, Yuan HA, Fredrickson BE, Lubicky JP (1983) The value of computed tomography in thoracolumbar fractures. An analysis of one hundred consecutive cases and a new classification. J Bone Jt Surg Am 65:461–473

    Article  CAS  Google Scholar 

  18. Lee JY, Vaccaro AR, Schweitzer KM, Lim MR, Baron EM, Rampersaud R et al (2007) Assessment of injury to the thoracolumbar posterior ligamentous complex in the setting of normal-appearing plain radiography. Spine J 7:422–427. https://doi.org/10.1016/j.spinee.2006.07.014

    Article  PubMed  Google Scholar 

  19. Rihn JA, Yang N, Fisher C, Saravanja D, Smith H, Morrison WB et al (2010) Using magnetic resonance imaging to accurately assess injury to the posterior ligamentous complex of the spine: a prospective comparison of the surgeon and radiologist: clinical article. J Neurosurg Spine 12:391–396

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, School of Medicine, Chungbuk National University, Chungbuk National University Hospital, 776, 1sunhwan-ro, Heungdeok-gu, Cheongju-si, Chungcheongbuk-do, 361-763, Cheongju, Republic of Korea

    Yong-Min Kim, Seung-Myung Choi & Min-Yong Ahn

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  1. Yong-Min Kim
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Correspondence to Seung-Myung Choi.

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Kim, YM., Choi, SM. & Ahn, MY. Comparison of sagittal values between lateral decubitus plain radiography and supine computed tomography in thoracolumbar fractures: a greater degree of kyphosis is observed in plain radiography than CT. Arch Orthop Trauma Surg 138, 745–755 (2018). https://doi.org/10.1007/s00402-018-2889-x

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