title: Segmental lumbar lordosis: manual versus computer-assisted measurement using seven different techniques.
abstract: OBJECTIVE
  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.
authors.affiliation: Virginia Spine Institute, Reston, Virginia 20190, USA.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Schuler
authors.forename: Brian R
authors.initials: BR
authors.lastname: Subach
authors.forename: Charles L
authors.initials: CL
authors.lastname: Branch
authors.forename: Kevin T
authors.initials: KT
authors.lastname: Foley
authors.forename: J Kenneth
authors.initials: JK
authors.lastname: Burkus
mesh_terms: D016477:Artifacts; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D007405:Intervertebral Disc Displacement / Q000601:surgery; D008141:Lordosis / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D015588:Observer Variation; D011237:Predictive Value of Tests; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods; D011859:Radiography / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012447:Sacrum / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D013123:Spinal Fusion / Q000592:standards