The Reliability of the Projection Area Per Length Squared for Measuring Lumbar Lordosis on Lateral Radiographs: A Comparison with Cobb Method

Murat Golpinar; Erdal Komut

doi:10.58600/eurjther-28-4-0091

Authors

Murat Golpinar Hitit University, Faculty of Medicine, Department of Anatomy, Çorum, Turkey https://orcid.org/0000-0001-9419-5993
Erdal Komut Hitit University, Faculty of Medicine, Department of Radiology, Çorum, Turkey https://orcid.org/0000-0003-2656-0420

DOI:

https://doi.org/10.58600/eurjther-28-4-0091

Keywords:

Cobb angle, length squared, lumbar lordosis, planimetry, radiography

Abstract

Objective: The assessment of the degree of lumbar lordosis in patients with spinal disorders is essential to determine disease progression and the effectiveness of treatment. The aim of this study was to examine the reliability of the projection area per length squared (PAL) for measuring lumbar lordosis on lateral radiographs and to compare it with the Cobb method.

Methods: Two independent investigators measured lumbar lordosis twice on 100 lateral radiographs using PAL and Cobb methods. Intra- and interobserver agreements of each radiological method were evaluated using intraclass correlation coefficients (ICC) and Bland–Altman plots. Correlations between the PAL estimations and Cobb angle measurements were tested using the Spearman rank correlation coefficient.

Results: Intra- and interobserver agreements for PAL and Cobb methods were excellent with all ICC values>0.976. The Bland–Altman plots indicated strong intra-observer and interobserver concordance in the measurement of the lumbar lordosis using the PAL method. A strong correlation was determined between the PAL and Cobb angle values in the first and second measurements (r=0.825; p<0.001 and r=0.815; p<0.001, respectively).

Conclusion: The PAL technique is easy to apply on digital images and provides quantitative information independent of the vertebral surface pathologies of the end vertebrae. It could be used as an alternative and potent diagnostic criterion for evaluating lumbar lordosis.

Metrics

Metrics Loading ...

References

Been E, Kalichman L. Lordosi lombare. Spine J. 2014;14(1):87-97.

Sparrey CJ, Bailey JF, Safaee M, Clark AJ, Lafage V, Schwab F, et al. Etiology of lumbar lordosis and its pathophysiology: a review of the evolution of lumbar lordosis, and the mechanics and biology of lumbar degeneration. Neurosurg Focus. 2014;36(5):E1.

Suzuki H, Endo K, Mizuochi J, Kobayashi H, Tanaka H, Yamamoto K. Clasped position for measurement of sagittal spinal alignment. Eur Spine J. 2010;19(5):782-6.

Diebo BG, Varghese JJ, Lafage R, Schwab FJ, Lafage V. Sagittal alignment of the spine: what do you need to know? Clin Neurol Neurosurg. 2015;139:295-301.

Schuler TC, Subach BR, Branch CL, Foley KT, Burkus JK, Lumbar Spine Study Group. Segmental lumbar lordosis: manual versus computer-assisted measurement using seven different techniques. Clin Spine Surg. 2004;17(5):372-9.

Cobb J. Outline for the study of scoliosis. Instr Course Lect. 1948;5:261-75.

Hwang J-H, Modi HN, Suh S-W, Hong J-Y, Park Y-H, Park J-H, et al. Reliability of lumbar lordosis measurement in patients with spondylolisthesis: a case-control study comparing the Cobb, centroid, and posterior tangent methods. Spine. 2010;35(18):1691-700.

Dimar JR, Carreon LY, Labelle H, Djurasovic M, Weidenbaum M, Brown C, et al. Intra-and inter-observer reliability of determining radiographic sagittal parameters of the spine and pelvis using a manual and a computer-assisted methods. Eur Spine J. 2008;17(10):1373-9.

Vrtovec T, Pernuš F, Likar B. A review of methods for quantitative evaluation of spinal curvature. Eur Spine J. 2009;18(5):593-607.

Russell BS, Muhlenkamp-Wermert KA, Hoiriis KT. Measurement of lumbar Lordosis: a comparison of 2 alternatives to the cobb angle. J Manipulative Physiol Ther. 2020;43(8):760-767.

Jørgensen LB, Sørensen JA, Jemec GB, Yderstræde KB. Methods to assess area and volume of wounds–a systematic review. Int Wound J. 2016;13(4):540-53.

Kuru O, Sahin B, Kaplan S. Alternative approach to evaluating lumbar lordosis on direct roentgenograms: projection area per length squared. Anat Sci Int. 2008;83(2):83-8.

Voutsinas SA, MacEwen GD. Sagittal profiles of the spine. Clin Orthop Relat Res. 1986(210):235-42.

Polly Jr DW, Kilkelly FX, McHale KA, Asplund LM, Mulligan M, Chang AS. Measurement of lumbar lordosis: evaluation of intraobserver, interobserver, and technique variability. Spine. 1996;21(13):1530-5.

Chernukha KV, Daffner RH, Reigel DH. Lumbar lordosis measurement: a new method versus Cobb technique. Spine. 1998;23(1):74-9.

Harrison DE, Harrison DD, Cailliet R, Janik TJ, Holland B. Radiographic analysis of lumbar lordosis: centroid, Cobb, TRALL, and Harrison posterior tangent methods. Spine. 2001;26(11):e235-e42.

Chen Y-L. Vertebral centroid measurement of lumbar lordosis compared with the Cobb technique. Spine. 1999;24(17):1786.

Gore DR, Sepic SB, Gardner GM. Roentgenographic findings of the cervical spine in asymptomatic people. Spine.1986;11(6):521-4.

Stokes IAF. Point of view: lumbar lordosis measurement: a new method versus Cobb technique. Spine. 1998;23(1):79-80.

Lee JS, Goh TS, Park SH, Lee HS, Suh KT. Radiographic measurement reliability of lumbar lordosis in ankylosing spondylitis. Eur Spine J. 2013;22(4):813-8.

Zhang J, Lou E, Shi X, Wang Y, Hill DL, Raso JV, et al. A computer- aided Cobb angle measurement method and its reliability. Clin Spine Surg. 2010;23(6):383-7.