A Comparative Study of the Accuracy and Reliability of Lordosis Lumbar Spine Measurement Using a Mobile Phone Application and a Picture Archiving and Communication System (PACS)
Article Sidebar
Main Article Content
Abstract
Background: Lumbar lordosis angle is a critical parameter for spinal surgeons to achieve optimal outcomes during surgery. However, traditional fluoroscopic imaging lacks built-in tools for accurate angle measurement, prompting surgeons to rely on subjective estimations. This study introduces the "Cobbter technique," a novel method employing a smartphone camera for objective lordosis angle measurement.
Objective: We aimed to compare the accuracy and reliability of the Cobbter technique against the Pictures Archiving and Communication system (PACS) angle measuring tool, a gold standard in clinical settings.
Methods: We retrospectively analyzed patients undergoing lateral lumbosacral radiography at Surin Hospital's orthopedic department. Two independent investigators measured the lordosis angle using both the Cobbter technique (CT) and the PACS tool (PT).
Results: The study included 32 lateral lumbosacral radiographs. The Cobbter technique demonstrated no statistically significant difference compared to PACS measurements (p=0.26). Subgroup analysis in patients with hyperlordosis (>40 degrees) further confirmed this equivalence (p=0.517). Notably, the CT method exhibited excellent inter-observer (ICC=0.946) and intra-observer (ICC=0.998) reliability.
Conclusion: The Cobbter technique offers a valid and reliable alternative for measuring lordosis angle, particularly when appropriate imaging protocols are followed. Future studies should explore its applicability to other spinal parameters like scoliosis angles.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
Been E, Gómez-Olivencia A, Kramer PA. The Study of the Human Spine and Its Evolution: State of the Art and Future Perspectives. In: Been E, Gómez-Olivencia A, Kramer PA, editor. Spinal Evolution: Morphology, Function, and Pathology of the Spine in Hominoid Evolution. Cham, Switzerland : Springer International Publishing ; 2019 : 1–14.
Joseph SA Jr, Moreno AP, Brandoff J, Casden AC, Kuflik P, Neuwirth MG. Sagittal plane deformity in the adult patient. J Am Acad Orthop Surg 2009;17(6):378-88. doi: 10.5435/00124635-200906000-00006.
Laouissat F, Sebaaly A, Gehrchen M, Roussouly P. Classification of normal sagittal spine alignment: refounding the Roussouly classification. Eur Spine J 2018;27(8):2002-11. doi: 10.1007/s00586-017-5111-x.
Skaf GS, Ayoub CM, Domloj NT, Turbay MJ, El-Zein C, Hourani MH. Effect of age and lordotic angle on the level of lumbar disc herniation. Adv Orthop 2011;2011:950576. doi: 10.4061/2011/950576.
Diebo BG, Ferrero E, Lafage R, Challier V, Liabaud B, Liu S, et al. Recruitment of compensatory mechanisms in sagittal spinal malalignment is age and regional deformity dependent: a full-standing axis analysis of key radiographical parameters. Spine (Phila Pa 1976) 2015;40(9):642-9. doi: 10.1097/BRS.0000000000000844.
Roussouly P, Nnadi C. Sagittal plane deformity: an overview of interpretation and management. Eur Spine J 2010;19(11):1824-36. doi: 10.1007/s00586-010-1476-9.
Xiaohua MH, KyeongAh J, HanSuk H, JooHyun KH, SungEun K. A comparison of the validity and reliability between a digital radiographic imaging system and manual method in measuring the Cobb angle. Scoliosis 2013;8(Suppl 2):O20. doi:10.1186/1748-7161-8-S2-O20
Kraturerk C, Poopitaya S, Chitragran R. COMPARISON OF THE COBB ANGLE MEASUREMENT BETWEEN MANUAL AND DIGITAL METHODS AMONG FIVE MILITARY HOSPITALS. J Southeast Asian Med Res 2021:5(2):51-7. DOI: https://doi.org/10.55374/jseamed.v5i2.88
Tanure MC, Pinheiro AP, Oliveira AS. Reliability assessment of Cobb angle measurements using manual and digital methods. Spine J 2010;10(9):769-74. doi: 10.1016/j.spinee.2010.02.020.
Wu W, Liang J, Du Y, Tan X, Xiang X, Wang W, et al. Reliability and reproducibility analysis of the Cobb angle and assessing sagittal plane by computer-assisted and manual measurement tools. BMC Musculoskelet Disord 2014;15:33. doi: 10.1186/1471-2474-15-33.
Cobb JR. Outline for the study of scoliosis. Am Acad Orthop Surg Instr Lect. 1948;5:261-275.
O’Brien MF, Kuklo TR, Blanke KM, Lenke LG. Spinal Deformity Study Group Radiographic Measurement Manual. Memphis, Tenn.: Medtronic Sofamor Danek USA Inc. ; 2008.
Saraste H, Broström LA, Aparisi T, Axdorph G. Radiographic measurement of the lumbar spine. A clinical and experimental study in man. Spine (Phila Pa 1976) 1985;10(3):236-41. doi: 10.1097/00007632-198504000-00008.
Qu Z, Deng B, Gao X, Pan B, Sun W, Feng H. The association between Roussouly sagittal alignment type and risk for adjacent segment degeneration following short-segment lumbar interbody fusion: a retrospective cohort study. BMC Musculoskelet Disord 2022;23(1):653. doi: 10.1186/s12891-022-05617-x.
Bari TJ, Hansen LV, Gehrchen M. Surgical correction of Adult Spinal Deformity in accordance to the Roussouly classification: effect on postoperative mechanical complications. Spine Deform 2020;8(5):1027-37. doi: 10.1007/s43390-020-00112-6.
Panjabi MM. Clinical spinal instability and low back pain. J Electromyogr Kinesiol 2003;13(4):371-9. doi: 10.1016/s1050-6411(03)00044-0.
Ketenci İE, Yanık HS, Erdoğan Ö, Adıyeke L, Erdem Ş. Reliability of 2 Smartphone Applications for Cobb Angle Measurement in Scoliosis. Clin Orthop Surg 2021;13(1):67-70. doi: 10.4055/cios19182.
Shaw M, Adam CJ, Izatt MT, Licina P, Askin GN. Use of the iPhone for Cobb angle measurement in scoliosis. Eur Spine J 2012;21(6):1062-8. doi: 10.1007/s00586-011-2059-0.
