Skip to main content
SpringerLink
Log in

Accuracy and Precision of Seven Radiography-Based Measurement Methods of Vertebral Axial Rotation in Adolescent Idiopathic Scoliosis

  • Classification/Measurement
  • Published:
Spine Deformity Aims and scope Submit manuscript

Abstract

Study Design

Assessment of vertebral axial rotation measurement methods.

Objectives

To assess the accuracy and precision of seven radiography-based vertebral axial rotation measurement methods for typical scoliotic deformity before and after posterior instrumentation.

Summary of Background Data

Vertebral axial rotation is an important component to evaluate transverse plane scoliotic deformities. Several measurement methods were developed based on coronal plane radiographs or computerized 3D reconstruction. Their ability to accurately and precisely measure axial rotation, either pre- or postoperatively, is not well known.

Methods

Two synthetic vertebrae, with and without instrumentation, were fixed in a jig allowing 3D rotation manipulations. Fifty-three configurations of 3D rotations were radiographed. Two observers evaluated seven measurement methods: one visual estimation, two ruler-based (Nash-Moe and Perdriolle), one analytical (Stokes), and three 3D-reconstruction techniques (based on pedicles, based on eight vertebra landmarks, and a surface-based reconstruction software SterEOS). Measurements were repeated one week later.

Results

Intraobserver precision ranged from 2.0° (Perdriolle/SterEOS) to 3.6° (visual estimation) for the noninstrumented vertebra, and from 2.2° (SterEOS) to 9.7° (Nash-Moe) for the instrumented vertebra. Interobserver precision ranged from 1.2° (SterEOS) to 9.3° (Nash-Moe) for the noninstrumented vertebra, and from 1.7° (SterEOS) to 6.2° (Visual Estimation) for the instrumented vertebra. Accuracy of the methods ranged from 2.1° with SterEOS to 9.1° with Nash-Moe ruler. The measurement error was significantly associated with the level of axial rotation for Nash-Moe and 3D reconstruction techniques with low to moderate correlation.

Conclusions

The majority of radiography-based methods measured vertebral axial rotation with an average error of 2° to 5°. The Nash-Moe method should be avoided, considering its inaccuracy greater than 9°. The instrumentation did not compromise the precision or the accuracy of measurement. The measurement accuracy of 3D reconstruction methods was impaired by the severity of the axial rotation.

Level of Evidence

N/A.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Villemure I, Aubin CE, Grimard G, et al. Progression of vertebral and spinal three-dimensional deformities in adolescent idiopathic scoliosis: a longitudinal study. Spine (Phila Pa 1976) 2001;26:2244–50.

    Article  CAS  Google Scholar 

  2. Stokes IA. Three-dimensional terminology of spinal deformity. A report presented to the Scoliosis Research Society by the Scoliosis Research Society Working Group on 3-D terminology of spinal deformity. Spine (Phila Pa 1976) 1994;19:236–48.

    Article  CAS  Google Scholar 

  3. Lam GC, Hill DL, Le LH, et al. Vertebral rotation measurement: a summary and comparison of common radiographic and CT methods. Scoliosis 2008;3:16.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Kuklo TR, Potter BK, Lenke LG. Vertebral rotation and thoracic torsion in adolescent idiopathic scoliosis: what is the best radiographic correlate? J Spinal Disord Tech 2005;18:139–47.

    Article  PubMed  Google Scholar 

  5. Hefti E Pathogenesis and biomechanics of adolescent idiopathic scoliosis (AIS). J Child Orthop 2013;7:17–24.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Kouwenhoven JWM, Castelein RM. The pathogenesis of adolescent idiopathic scoliosis: review of the literature. Spine 2008;33: 2898–908.

    Article  PubMed  Google Scholar 

  7. Nault M-L, Mac-Thiong JM, Roy-Beaudry M, et al. Three-dimensional spinal morphology can differentiate between progressive and nonprogressive patients with adolescent idiopathic scoliosis at the initial presentation: a prospective study. Spine (Phila Pa 1976) 2014;39:E601–6.

    Article  Google Scholar 

  8. Courvoisier A, Drevelle X, Dubousset J, Skalli W. Transverse plane 3D analysis of mild scoliosis. Eur Spine J 2013;22:2427–32.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Lee S-M, Suk S-I, Chung ER. Direct vertebral rotation: a new technique of three-dimensional deformity correction with segmental pedicle screw fixation in adolescent idiopathic scoliosis. Spine 2004;29:343–9.

    Article  PubMed  Google Scholar 

  10. Nash Jr C, Moe JH. A study of vertebral rotation. J Bone Joint Surg 1969;51:223–9.

    Article  PubMed  Google Scholar 

  11. Perdriolle R, Vidal J. Thoracic idiopathic scoliosis curve evolution and prognosis. Spine 1985;10:785–91.

    Article  CAS  PubMed  Google Scholar 

  12. Stokes IA. Axial rotation component of thoracic scoliosis. J Orthop Res 1989;7:702–8.

    Article  CAS  PubMed  Google Scholar 

  13. Cheriet F, Laporte C, Kadoury S, et al. A novel system for the 3-D reconstruction of the human spine and rib cage from biplanar X-ray images. IEEE Trans Biomed Eng 2007;54:1356–8.

    Article  Google Scholar 

  14. Aaro S, Dahlborn M. Estimation of vertebral rotation and the spinal and rib cage deformity in scoliosis by computer tomography. Spine 1981;6:460–7.

    Article  CAS  PubMed  Google Scholar 

  15. Ho EK, Upadhyay SS, Chan FL, et al. New methods of measuring vertebral rotation from computed tomographic scans: an intraobserver and interobserver study on girls with scoliosis. Spine 1993 ; 18:1173–7.

    Article  CAS  PubMed  Google Scholar 

  16. Vrtovec T, Permis F, Likar B. A review of methods for quantitative evaluation of axial vertebral rotation. Eur Spine J 2009;18:1079–90.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Chi WM, Cheng CW, Yeh WC, et al. Vertebral axial rotation measurement method. Comput Methods Programs Biomed 2006;81:8–17.

    Article  PubMed  Google Scholar 

  18. Gunzburg R, Gunzburg J, Wagner J, Fraser RD. Radiologic interpretation of lumbar vertebral rotation. Spine 1991;16:660–4.

    Article  CAS  PubMed  Google Scholar 

  19. Pinheiro AP, Tanure MC, Oliveira AS. Validity and reliability of a computer method to estimate vertebral axial rotation from digital radiographs. Eur Spine J 2010;19:415–20.

    Article  PubMed  Google Scholar 

  20. Hecquet J, Legaye J, Duval-Beaupere G. Access to a three-dimensional measure of vertebral axial rotation. Eur Spine J 1998;7:206–11.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Skalli W, Lavaste F, Descrimes JL. Quantification of three-dimensional vertebral rotations in scoliosis: what are the true values? Spine 1995;20:546–53.

    Article  CAS  PubMed  Google Scholar 

  22. Stokes IA, Bigalow LC, Moreland MS. Measurement of axial rotation of vertebrae in scoliosis. Spine 1986;11:213–8.

    Article  CAS  PubMed  Google Scholar 

  23. Glaser DA, Doan J, Newton PO. Comparison of 3-dimensional spinal reconstruction accuracy: biplanar radiographs with EOS versus computed tomography. Spine 2012;37:1391–7.

    Article  PubMed  Google Scholar 

  24. Mukaka M. A guide to appropriate use of correlation coefficient in medical research. Malawi Med J 2012;24:69–71.

    CAS  PubMed  PubMed Central  Google Scholar 

  25. Drerup B. Principles of measurement of vertebral rotation from frontal projections of the pedicles. J Biomech 1984;17:923–35.

    Article  CAS  PubMed  Google Scholar 

  26. Ilharreborde B, Steffen JS, Nectoux E, et al. Angle measurement reproducibility using EOS three-dimensional reconstructions in adolescent idiopathic scoliosis treated by posterior instrumentation. Spine 2011;36:E1306–13.

    Article  PubMed  Google Scholar 

  27. Upasani VV, Chambers RC, Dalai AH, et al. Grading apical vertebral rotation without a computed tomography scan: a clinically relevant system based on the radiographic appearance of bilateral pedicle screws. Spine 2009;34:1855–62.

    Article  PubMed  Google Scholar 

  28. Liu RW, Yaszay B, Glaser D, et al. A method for assessing axial vertebral rotation based on differential rod curvature on the lateral radiograph. Spine 2012;37:E1120–5.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Polytechnique Montreal, Department of Mechanical Engineering, P.O. Box 6079, Downtown Station, H3C 3A7, Montreal, Quebec, Canada

    Laure Boyer PhD, Samuel Kadoury PhD, PEng & Carl-Eric Aubin PhD, PEng

  2. Research Center, Sainte-Justine University Hospital Center, 3175, Cote Sainte-Catherine Road, H3T 1C5, Montreal, Quebec, Canada

    Laure Boyer PhD, Jesse Shen MSc, Stefan Parent MD, PhD, Samuel Kadoury PhD, PEng & Carl-Eric Aubin PhD, PEng

Authors
  1. Laure Boyer PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jesse Shen MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stefan Parent MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Samuel Kadoury PhD, PEng
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Carl-Eric Aubin PhD, PEng
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Carl-Eric Aubin PhD, PEng.

Additional information

Author disclosures: LB (grants from Natural Sciences and Engineering Research Council of Canada, during the conduct of the study); JS (none); SP (grants from Canada Research Chair and the Natural Sciences and Engineering Research Council of Canada, during the conduct of the study; personal fees from Scoliosis Research Society, Canadian Spine Society, DePuy Synthes Spine, Medtronic, EOS-Imaging, and K2M; grants from DePuy Synthes Spine, Setting Scoliosis Straight Foundation, Medtronic, EOS-Imaging, Spinologics, Canadian Institutes of Health Research, Canadian Institutes of Health Research, Canadian Foundation for Innovation, Natural Sciences and Engineering Council of Canada, Fonds de Recherche Québec–Santé, and Orthopedic Research and Education Foundation; other from Spinologics and EOS-Imaging; Academic Chair in Pediatric Spinal Deformities of CHU Ste-Justine, outside the submitted work); SK (none); CEA (grants from Canada Research Chair, and Natural Sciences and Engineering Research Council of Canada, during the conduct of the study; grants from Natural Sciences and Engineering Research Council of Canada, Medtronic, Rodin4D, Zimmer CAS, and Canada First Research Excellence Funds, outside the submitted work).

Financially supported by the Natural Sciences and Engineering Research Council of Canada (industrial research chair with Medtronic of Canada).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Boyer, L., Shen, J., Parent, S. et al. Accuracy and Precision of Seven Radiography-Based Measurement Methods of Vertebral Axial Rotation in Adolescent Idiopathic Scoliosis. Spine Deform 6, 351–357 (2018). https://doi.org/10.1016/j.jspd.2017.12.004

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1016/j.jspd.2017.12.004

Keywords

Search

Navigation