Non-radiographic methods of measuring global sagittal balance: a systematic review

Abstract

BackgroundGlobal sagittal balance, describing the vertical alignment of the spine, is an important factor in the non-operative and operative management of back pain. However, the typical gold standard method of assessment, radiography, requires exposure to radiation and increased cost, making it unsuitable for repeated use. Non-radiologic methods of assessment are available, but their reliability and validity in the current literature have not been systematically assessed. Therefore, the aim of this systematic review was to synthesise and evaluate the reliability and validity of non-radiographic methods of assessing global sagittal balance.MethodsFive electronic databases were searched and methodology evaluated by two independent reviewers using the13-item, reliability and validity, Brink and Louw critical appraisal tool.ResultsFourteen articles describing six methodologies were identified from 3940 records. The six non-radiographic methodologies were biophotogrammetry, plumbline, surface topography, infra-red motion analysis, spinal mouse and ultrasound. Construct validity was evaluated for surface topography (R = 0.49 and R = 0.68, p < 0.001), infra-red motion-analysis (ICC = 0.81) and plumbline testing (ICC = 0.83). Reliability ranged from moderate (ICC = 0.67) for spinal mouse to very high for surface topography (Cronbach α = 0.985). Measures of agreement ranged from 0.9 mm (plumbline) to 22.94 mm (infra-red motion-analysis). Variability in study populations, reporting parameters and statistics prevented a meta-analysis.ConclusionsThe reliability and validity of the non-radiographic methods of measuring global sagittal balance was reported within 14 identified articles. Based on this limited evidence, non-radiographic methods appear to have moderate to very high reliability and limited to three methodologies, moderate to high validity. The overall quality and methodological approaches of the included articles were highly variable. Further research should focus on the validity of non-radiographic methods with a greater adherence to reporting actual and clinically relevant measures of agreement.

Spinopelvic alignment predicts disc calcification, displacement, and Modic changes: Evidence of an evolutionary etiology for clinically‐relevant spinal phenotypes

“…Our findings further broaden the understanding of spine degeneration and, subsequently, pain. Currently, imaging techniques with even lower ionizing radiation dose exposure (eg, EOS) in comparison to conventional plain radiographs or no such exposure, such as ultrasound and smartphones, can assess one's spinopelvic alignment . Such information can obtain a more personalized profile of an individual, knowing who is at risk for spinal phenotype development.…”

“…The role of genetics to the development of spinal degenerative phenotypes has been widely studied; however, heritability estimates vary from 26% to 77%. 9,51,52 Considering the potential possibility of genetic predisposition to PI, we can assume that genetics may play its part in the development of disc degenerative features by determining the PI and shape of the pelvis; thereby, degenerative changes of the disc and endplate region are induced rather than sole contribution from the disc degenerative process. As such, we propose an "Evolutionary Etiology" pathway with respect to clinically-relevant anterior column phenotypes (Figure 4).…”

Mobile Applications for Assessing Human Posture: A Systematic Literature Review

“…For example, biophotogrammetry is explored in [10][11][12]. Researchers have also investigated reference values for postural alignment [7] and compared them by analyzing their applicability, similarities and differences [13]. Among the reviews involving postural assessment methods, we highlight the studies by Porto et al [14] and Aroeira et al [15], which conducted reviews on computational methods for postural assessment.…”

Changes of the body posture in the sagittal plane of young adults during Matthiass test

“…Moreover, it is risky when used for repeated monitoring because of invasive character. Therefore, various examination methods enabling non-invasive posture assessment have been developed [3,4].…”