Roentgenographic Evaluation of Lumbar Spine Flexion-Extension in Asymptomatic Individuals

Hayes, Mark A.; Howard, Thomas C.; Gruel, Curtis R.; Kopta, Joseph A

doi:10.1097/00007632-198903000-00014

Cited by 260 publications

(125 citation statements)

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“…Because studies have reported large variability and high false positive rates with flexion-extension radiographs [5,16,25], we required a patient to meet one of the following criteria to be categorized as having instability: (1) two segments with either rotational or translational instability, or (2) one segment with both translational and rotational instability. Clinical variables were examined for univariate relationships with radiographic instability.…”

Section: Discussionmentioning

confidence: 99%

“…Although concerns about the validity of flexionextension radiographs have been raised [5,25,53], this method has become the standard by which lumbar instability is diagnosed [15,16,40,47]. Other proposed ''gold standards'' for diagnosing instability include intraoperative spinal stiffness measures or external fixation; however, these methods may not be practical for routine use in patients managed non-surgically [2,8].…”

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confidence: 99%

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Accuracy of the clinical examination to predict radiographic instability of the lumbar spine

2005

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Accuracy of the clinical examination to predict radiographic instability of the lumbar spine

2005

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“…However, indications for spinal fusion remain controversial. In patients with antero-or retrospondylolisthesis, radiographic evaluation of instability using lateral radiographs of the spine in flexion and extension is widely used as an indication for fusion, but this method has been reported to have poor sensitivity and specificity [8]. Especially in cases of lumbar-degenerated scoliosis, the patients have disc wedging involved with rotational instability, though the patients do not show antero-or retrospondylolisthesis on X-ray evaluation.…”

Section: Introductionmentioning

confidence: 99%

Rotational hypermobility of disc wedging using kinematic CT: preliminary study to investigate the instability of discs in degenerated scoliosis in the lumbar spine

et al. 2010

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The number of patients showing lumbar degenerative scoliosis, including disc wedging, has increased, and examination of the mechanism of spinal nerve compression due to lateral and rotational mobility of the lumbar spine is necessary. Thirty-two patients with L4-L5 disc wedging but without antero-or retrospondylolisthesis and ten age-matched controls were examined. The angle of disc wedging and change in the angle between left and right bending were evaluated by anterior-posterior X-ray images of patients while they were in a standing position. The degree of disc degeneration and existence of vacuum phenomena were evaluated at the L4-L5 discs. Rotational mobility between maximal right and left rotation was examined by computed tomography (CT). Rotational mobility was measured using the spinal transverse processes of L4 and L5. The relationship between these factors was statistically evaluated using multivariate analysis and Spearman's correlation test. There was a significant increase in the average rotational mobility of the L4-L5 disc-wedging group. In the L4-L5 disc-wedging group, the increased angle of disc wedging and change in the angle between left and right bending correlated with increased rotational mobility. The degree of disc degeneration did not affect rotational mobility. However, existence of vacuum phenomena increased the rotational mobility of the L4-L5 disc-wedging group. This is the first study to evaluate the rotational hypermobility of L4-L5 disc wedging in patients without antero-or retrospondylolisthesis using kinematic CT. Increases in the wedging angle and abnormal instability of lateral bending correlated with increased rotational mobility. For surgical planning of degenerative L4-L5 disc wedging, it is important to consider rotational hypermobility using kinematic CT or X-ray imaging findings of lateral bending.

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“…Knowing that the Cobbometer is reliable in repeated readings as shown by the inter-and intra-observer agreements tells us only about its precision however, and not necessarily about its measurement bias. Further improvements in accuracy (i.e., increases in precision and reductions in bias) may be necessary when evaluating TDR ROM as this motion has been suggested to be less than that observed for the normal spine [5,6].…”

Section: Introductionmentioning

confidence: 99%

Radiographic total disc replacement angle measurement accuracy using the Oxford Cobbometer: precision and bias

et al. 2008

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Total disc replacement (TDR) clinical success has been reported to be related to the residual motion of the operated level. Thus, accurate measurement of TDR range of motion (ROM) is of utmost importance. One commonly used tool in measuring ROM is the Oxford Cobbometer. Little is known however on its accuracy (precision and bias) in measuring TDR angles. The aim of this study was to assess the ability of the Cobbometer to accurately measure radiographic TDR angles. An anatomically accurate synthetic L4-L5 motion segment was instrumented with a CHARITE artificial disc. The TDR angle and anatomical position between L4 and L5 was fixed to prohibit motion while the motion segment was radiographically imaged in various degrees of rotation and elevation, representing a sample of possible patient placement positions. An experienced observer made ten readings of the TDR angle using the Cobbometer at each different position. The Cobbometer readings were analyzed to determine measurement accuracy at each position. Furthermore, analysis of variance was used to study rotation and elevation of the motion segment as treatment factors. Cobbometer TDR angle measurements were most accurate (highest precision and lowest bias) at the centered position (95.5%), which placed the TDR directly inline with the x-ray beam source without any rotation. In contrast, the lowest accuracy (75.2%) was observed in the most rotated and off-centered view. A difference as high as 4°between readings at any individual position, and as high as 6°between all the positions was observed. Furthermore, the Cobbometer was unable to detect the expected trend in TDR angle projection with changing position. Although the Cobbometer has been reported to be reliable in different clinical applications, it lacks the needed accuracy to measure TDR angles and ROM. More accurate ROM measurement methods need to be developed to help surgeons and researchers assess radiological success of TDRs.

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Roentgenographic Evaluation of Lumbar Spine Flexion-Extension in Asymptomatic Individuals

Cited by 260 publications

References 0 publications

Accuracy of the clinical examination to predict radiographic instability of the lumbar spine

Accuracy of the clinical examination to predict radiographic instability of the lumbar spine

Rotational hypermobility of disc wedging using kinematic CT: preliminary study to investigate the instability of discs in degenerated scoliosis in the lumbar spine

Radiographic total disc replacement angle measurement accuracy using the Oxford Cobbometer: precision and bias

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