title: The accuracy of clinical kyphosis examination for detection of thoracic vertebral fractures: comparison of direct and indirect kyphosis measures.
abstract: OBJECTIVE
  To compare the accuracies of two simple physical examination maneuvers for detecting the presence of thoracic vertebral fractures (VF) diagnosed by radiography: direct measurement of kyphosis angle (KA, in degrees) and indirect measurement using wall-occiput distance (WOD, in cm).
  
  
  METHODS
  Subjects were 280 women (average age, 54.5 years; range, 18-92) referred for assessment of osteoporosis. KA was measured from T4 to T12 using a digital inclinometer while WOD was measured with the patient in a standardized position. VF were diagnosed on radiographs using semi-quantitative morphometry.
  
  
  RESULTS
  KA and WOD were moderately correlated (r = 0.72, p<10(-11)). KA increased by 3.7(o) (95% CI, 2.6-4.8(o)) for each VF (p = 4x 10(-11)) and WOD rose 1.3 cm (95% CI, 0.8-1.7 cm) per VF (p = 2 x 10(-11)). The areas under the receiver operating characteristic curves were 0.72 (95% CI, 0.65-0.79) for KA and 0.76 (95% CI, 0.69-0.82) for WOD, which were not significantly different (p = 0.13).
  
  
  CONCLUSIONS
  Given similar performances of direct and indirect measures of kyphosis, we propose that WOD should be used in clinical practice, with a clinical threshold of WOD>4.0 cm as an indication to consider spine radiography. At this WOD threshold, sensitivity was 41% (95% CI, 31-52%) and specificity was 92% (95% CI, 87-95%). WOD should be considered for use in the clinical assessment of osteoporosis patients.
authors: Department of Radiology and Diagnostic Imaging, and Division of Endocrinology and Metabolism, University of Alberta, Edmonton, Alberta, Canada. kerrygs@telusplanet.net
authors: K
authors: K
authors: Siminoski
authors: R S
authors: RS
authors: Warshawski
authors: H
authors: H
authors: Jen
authors: K-C
authors: KC
authors: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000175:diagnosis* / Q000503:physiopathology; D010808:Physical Examination / Q000295:instrumentation / Q000379:methods / Q000592:standards*; D011859:Radiography; D016103:Spinal Fractures / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D055815:Young Adult