Abstract
The objective of this study was to evaluate an X-ray films analysis software, i.e. to estimate the reliability and validity of clinical measurements by means of this software. The authors first performed tests of precision and reproducibility of measures. The precision for dynamic modules was estimated at ±2° for the lumbar analysis and ±3° for the cervical one. Mean reproducibility coefficients calculated for postural modules are about 4° for the angular parameters and 3 mm for the linear ones. We also evaluated clinical applicability of the software through its validity. Reference values calculated on a population of healthy subjects showed agreement with the literature. Then, when analysing postural X-ray films of severe scoliotic patients, we found that inter-observer reproducibility coefficients show a lower reliability of measurements; the main cause seems to be the low visibility of anatomic landmarks due to the quality of X-ray films and to the degree of deformity. This study allowed to better estimate the reliability and the usefulness of this tool, allowing for multicentric studies and exchanges.
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Notes
once agreement between observers and normal distributions have been checked
References
Altmann D, Bland M (1983) Measurement in medicine: the analysis of method comparison studies. Statistician 32:307–317
Bernhardt M, Bridwell KH (1989) Segmental analysis of the sagittal plane alignment of the normal thoracic and lumbar spines and thoracolumbar junction. Spine 14(7):717–721
Cheung J, Wever DJ, Veldhuizen AG, Klein JP, Verdonck B, Nijlunsing R, Cool JC, Van Horn JR (2002) The reliability of quantitative analysis on digital images of the scoliotic spine. Eur Spine J 11:535–542
Duval-Beaupère G, Schimt C, Cosson PH (1992) A barycentrometric study of the sagittal shape of spine and pelvis. Ann Biomed Eng 20(4):51–62
Gelb DE, Lenke LG, Bridwell KH, Blanke KB, McEnery KW (1995) An analysis of sagittal spinal alignment in 100 asymptomatic middle and older aged volunteers. Spine 20(12):1351–1358
Guigui P, Levassor N et al (2003) Physiological value of pelvic and spinal parameters of sagittal balance: analysis of 250 healthy volunteers. Rev Chir Orthop Reparatrice Appar Mot 89(6):496–506
Hopkins WG (2000) Measures of reliability in sports medicine and science. Sports Med 30:1–15
Jackson RP, Kanemura T, Kawakami N, Hales C (2000) Lumbopelvic lordosis and pelvic balance on repeated standing lateral radiographs of adults volunteers and untreated patients with constant low back pain. Spine 25(5):575–586
Jackson RP, McManus AC (1994) Radiographic analysis of sagittal plane alignment and balance in standing volunteers and patients with low back pain matched for age, sex and size. Spine 19(14):1611–1618
Kauffmann C, Godbout B, De Guise J (1998) Simplified active contour model applied to bone structures segmentation in digital radiographs. In: Medical imaging 1998, SPIE’S International Symposium, San Diego, California, USA, 21–27 February, 3338: 663–672
Legaye J, Hecquet J, Marty C, Duval-Beaupère G (1993) Equilibre sagittal du rachis. Rachis 5(5):215–226
Marty C, Boisaubert B, Descamps H, Montigny JP, Hecquet J, Legaye J, Duval-Beaupère G (2002) The sagittal anatomy of the sacrum among young adults, infants, and spondylolisthesis patients. Eur Spine J 11(2):119–125
Pearcy MJ, Bogduk N (1988) Instantaneous axes of rotation of the lumbar intervertebral joints. Spine 13(9):1033–1041
Portney LG, Watkins MP (1993) Foundations of clinical research Applications and practice. Appleton& Lange, Norwalk ISBN 0-8385-1065-5, pp 509–516
Precision measurement of disc height, vertebral height and sagittal plane displacement from lateral radiographic views of lumbar spine (1997) Clinical biomechanics 12(suppl):1
Prothèses discales et arthrodèses dans la pathologie dégénérative du rachis lombaire - rapport de l’ANAES, Mai 2000
Rajnics P, Pomero V, De Guise J, Mouilleseaux B, Lavaste F, Skalli W (2001) Computer-assisted assessment of spinal sagittal plane radiographs. J Spinal Disord 14:135–142
Rillardon L, Levassor N, Guigui P, Wodecki P, Cardinne L, Templier A, Skalli W (2003) Validation of a tool to measure pelvic and spinal parameters of sagittal balance. Rev Chir Orthop Reparatrice Appar Mot 89(3):218–227
Sai Wing Lee, Kris WN Wong et al (2002) Development and validation of a new technique for assessing lumbar spine motion. Spine 27:E215–E220
Shea KG, Stevens PM, Nelson M, Smith Jt, Masters KS, Yandow S (1998) A comparison of manual versus computer-assisted radiographic measurement. Intraobserver measurement variability for Cobb angles. Spine 23:551–555
Shrout P, Fleiss J (1979) Intraclass correlations: uses in assessing rater reliability. Psychol Bull 68:420–428
Stagnara P, De Mauroy JC, Dran G et al (1982) Reciprocal angulation of vertebral bodies in a sagittal plane: approach to references for evaluation of kyphosis and lordosis. Spine 7(4):335–342
Templier A, Skalli W, Diop A, Vital JM, Mazel C, Saillant G, Delecrin J, Dubousset J, Lavaste F (1999) Evaluation radiographique quantitative des arthrodèses rachidiennes lombaires: protocole et analyse préliminaire d’une série multicentrique de 119 cas. Rachis, pp 23–37
Toussignant M, Duclos E et al (2002) Validity study for the cervical range of motion device used for lateral flexion in patients with neck pain. Spine 27:812–817
Troyanovich SJ, Cailliet R, Janik TJ, Harrison DD, Harrison DE (1997) Radiographic mensuration characteristics of the sagittal lumbar spine from a normal population with a method to synthesize prior studies of lordosis. J Spinal Disord 10:380–386
Vaz G, Roussouly P, Berthonnaud E, Dimnet J (2002) Sagittal morphology and equilibrium of pelvis and spine. Eur Spine J 11(1):80–87
Voutsinas SA, MacEwen GD (1986) Sagittal profiles of the spine. Clin Orthop 210:235–242
White Paper on Sagittal Plane Alignment, Scoliosis Research Society
Acknowledgements
The authors acknowledge H. Carrier, A. Raoult, who participated to inter-observer measurements, A. Jacotot, V. Pomero and I. Kojadinovic who helped us managing the statistical tests and A. Mitulescu, who kindly offered her support in editing and revising this paper. Note: Spineview software was developed by the teams of LBM& LIO, in collaboration with the Surgiview company (Paris, France).
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Champain, S., Benchikh, K., Nogier, A. et al. Validation of new clinical quantitative analysis software applicable in spine orthopaedic studies. Eur Spine J 15, 982–991 (2006). https://doi.org/10.1007/s00586-005-0927-1
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DOI: https://doi.org/10.1007/s00586-005-0927-1