Analysis of accuracy of kyphotic angle measurement for vertebral osteoporotic compression fractures.
A reliable and reproducible measurement technique for the sagittal contour in vertebral fractures is paramount to clinical decision-making. This study was designed to determine the most reliable measurement technique in osteoporotic vertebral compression fracture. Fifteen lateral radiographs of thoracic and lumbar fractures were selected and measured on two separate occasions by three spine surgeons using six different measurement techniques (centroid, Harrison posterior tangent method and 4 different types of modified Cobb method). The radiograph quality was assessed and the center beam location was determined. The inter- and intraobserver variance of the Cobb method 4 and the Harrison posterior tangent method were significantly lower than for the other four methods. The intraobserver correlation coefficients were the most consistent using the Cobb method 4 (0.982), followed by the Harrison posterior tangent method (0.953) and Cobb method 1 (0.874). The intraobserver agreement (% of repeated measures within 5 degrees of the original measurement) ranged from 42% to 98% for each technique for all three observers, with the Cobb method 4 showing the best agreement (97.8%) followed by the Harrison posterior tangent method (93.7%). The Cobb method 4 and Harrison posterior tangent method, when applied to measuring the kyphosis, were reliable and had a similar small error range. The Cobb method 4 showed the best overall reliability. The centroid method and the other Cobb methods using a fractured endplate did not produce an accurate result due to inter- and intraobserver differences in determining the baseline.
Lee
Sang Won
SW
Department of Neurosurgery, St. Vincent Hospital, The Catholic University of Korea, Suwon, Korea.
Hong
Jae Taek
JT
Son
Byung Chul
BC
Sung
Jae Hoon
JH
Kim
Il Sub
IS
Park
Chun Kun
CK
D003627:Data Interpretation, Statistical; D003937:Diagnosis, Differential; D003951:Diagnostic Errors / Q000517:prevention & control; D050815:Fractures, Compression / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D006801:Humans; D007738:Kyphosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology; D015588:Observer Variation; D010024:Osteoporosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D011237:Predictive Value of Tests; D011859:Radiography / Q000379:methods* / Q000592:standards; D013902:Radiography, Thoracic / Q000379:methods / Q000592:standards; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016103:Spinal Fractures / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D013131:Spine / Q000000981:diagnostic imaging* / Q000473:pathology; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology