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. 2013 Jun;22(6):1362-7.
doi: 10.1007/s00586-013-2752-2. Epub 2013 Mar 31.

Reliability of cervical lordosis and global sagittal spinal balance measurements in adolescent idiopathic scoliosis

Christophe Vidal  1 , Brice Ilharreborde, Robin Azoulay, Guy Sebag, Keyvan Mazda
Affiliations

Reliability of cervical lordosis and global sagittal spinal balance measurements in adolescent idiopathic scoliosis

Christophe Vidal et al. Eur Spine J. 2013 Jun.

Abstract

Study design: Radiological reproducibility study.

Purpose: To assess intra and interobserver reliability of radiographic measurements for global sagittal balance parameters and sagittal spine curves, including cervical spine. Sagittal spine balance in adolescent idiopathic scoliosis (AIS) is a main issue and many studies have been reported, showing that coronal and sagittal deformities often involve sagittal cervical unbalance. Global sagittal balance aims to obtain a horizontal gaze and gravity line at top of hips when subject is in a static position, involving adjustment of each spine curvature in the sagittal plane. To our knowledge, no study did use a methodologically validated imaging analysis tool able to appreciate sagittal spine contours and distances in AIS and especially in the cervical region.

Methods: Lateral full-spine low-dose EOS radiographs were performed in 75 patients divided in three groups (control subjects, AIS, operated AIS). Three observers digitally analyzed twice each radiograph and 11 sagittal measures were collected for each image. Reliability was assessed calculating intraobserver Pearson's r correlation coefficient, interobserver intra-class correlation coefficient (ICC) completed with a two-by-two Bland-Altman plot analysis.

Results: This measurement method has shown excellent intra and interobserver reliability in all parameters, sagittal curvatures, pelvic parameters and global sagittal balance.

Conclusions: This study validated a simple and efficient tool in AIS sagittal contour analysis. It defined new relevant landmarks allowing to characterize cervical segmental curvatures and cervical involvement in global balance.

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Figures

Fig. 1
Fig. 1
Cervical spinal sagittal angles. Upper cervical lordosis (C1C3), global cervical lordosis (C2C6), lower cervical lordosis (C3C7) on plain EOS lateral radiographs
Fig. 2
Fig. 2
Thoracic kyphosis (T1T12), lumbar lordosis (L1L5), pelvic incidence (IP), pelvic version (VP) on plain EOS lateral radiographs
Fig. 3
Fig. 3
Global sagittal distances. External auditory canal plumb line (CAEPL), external auditory canal-C7 translation (CAEC7), external auditory canal-hips distance (CAEH), C7 plumb line on EOS lateral radiographs.
Fig. 4
Fig. 4
Bland–Altman plots graph for CAEH distance between observer 1 and observer 3. No major difference, good interobserver reproducibility
See this image and copyright information in PMC

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