Is There an Optimal Patient Stance for Obtaining a Lateral 36” Radiograph?

Horton, William C.; Brown, Courtney W.; Bridwell, Keith H.; Glassman, Steven D.; Suk, Se-Il; Charles, W.

doi:10.1097/01.brs.0000153698.94091.f8

Cited by 292 publications

(142 citation statements)

References 26 publications

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“…The lumbar lordosis angle (T12-L5) and sacral inclination angle were measured using lumbar lateral standing radiographs in a free-standing posture with fingers on the clavicles and shoulders at 45°of forward elevation [17], and osteophyte formation and disc height were determined as markers of degeneration. Osteophyte formation was evaluated using the Nathan classification (0-4) and the total score (osteophyte score, 0-20) for L1/2-L5/S1 in this classification was also determined [18].…”

Section: Radiographic Evaluationmentioning

confidence: 99%

Influence of spinal sagittal alignment, body balance, muscle strength, and physical ability on falling of middle-aged and elderly males

et al. 2013

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Objective Risk factors for falling in elderly people remain uncertain, and the effects of spinal factors and physical ability on body balance and falling have not been examined. The objective of this study was to investigate how factors such as spinal sagittal alignment, spinal range of motion, body balance, muscle strength, and gait speed influence falling in the prospective cohort study. Methods The subjects were 100 males who underwent a basic health checkup. Balance, SpinalMouse Ò data, grip strength, back muscle strength, 10-m gait time, lumbar lateral standing radiographs, body mass index, and fall history over the previous year were examined. Platform measurements of balance included the distance of movement of the center of pressure (COP) per second (LNG/TIME), the envelopment area traced by movement of the COP (E AREA), and the LNG/E AREA ratio. The thoracic/lumbar angle ratio (T/L ratio) and sagittal vertical axis (SVA) were used as an index of sagittal balance. Results LNG/TIME and E AREA showed significant positive correlations with age, T/L ratio, SVA, and 10-m gait time; and significant negative correlations with lumbar lordosis angle, sacral inclination angle, grip strength and back muscle strength. Multiple regression analysis showed significant differences for LNG/TIME and E AREA with T/L ratio, SVA, lumbar lordosis angle and sacral inclination angle (R 2 = 0.399). Twelve subjects (12 %) had experienced a fall over the past year. Age, T/L ratio, SVA, lumbar lordosis angle, sacral inclination angle, grip strength, back muscle strength, 10-m gait time, height of the intervertebral disc, osteophyte formation in radiographs and LNG/E AREA differed significantly between fallers and non-fallers. The group with SVA [ 40 mm (n = 18) had a significant higher number of subjects with a single fall (6 single fallers/18: p = 0.0075) and with multiple falls (4 multiple fallers/18: p = 0.0095). Conclusion Good spinal sagittal alignment, muscle strength and 10-m gait speed improve body balance and reduce the risk of fall. Muscle strength and physical ability are also important for spinal sagittal alignment. Body balance training, improvement of physical abilities including muscle training, and maintenance of spinal sagittal alignment can lead to prevention of fall.

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Section: Radiographic Evaluationmentioning

confidence: 99%

Influence of spinal sagittal alignment, body balance, muscle strength, and physical ability on falling of middle-aged and elderly males

et al. 2013

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“…1b). This posture is similar to the posture adopted for X-ray acquisition at Sainte Justine hospital, and recommended by Horton et al [9] as the most accurate for radiographic exposure.…”

Section: Acquisition Protocolmentioning

confidence: 59%

“…From the viewpoint of correlating the bone structure deformity and the surface asymmetry, an obvious choice is to adopt the same posture as the one used for X-rays, with the arms roll up to the clavicles (''clavicle'' position) [9]. To combine technical constraints, such as minimizing the occlusion of camera fields, another choice is a natural positioning of patients, using the traditional standing anatomical posture adopted by clinicians and by many other researchers [1,5,27].…”

Section: Introductionmentioning

confidence: 99%

Reliability of trunk shape measurements based on 3-D surface reconstructions

et al. 2007

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This study aimed to estimate the reliability of 3-D trunk surface measurements for the characterization of external asymmetry associated with scoliosis. Repeated trunk surface acquisitions using the Inspeck system (Inspeck Inc., Montreal, Canada), with two different postures A (anatomical position) and B (''clavicle'' position), were obtained from patients attending a scoliosis clinic. For each acquisition, a 3-D model of the patient's trunk was built and a series of measurements was computed. For each measure and posture, intraclass correlation coefficients (ICC) were obtained using a bivariate analysis of variance, and the smallest detectable difference was calculated. For posture A, reliability was fair to excellent with ICC from 0.91 to 0.99 (0.85 to 0.99 for the lower bound of the 95% confidence interval). For posture B, the ICC was 0.85 to 0.98 (0.74 to 0.99 for the lower bound of the 95% confidence interval). The smallest statistically significant differences for the maximal back surface rotation was 2.5 and 1.5°for the maximal trunk rotation. Apparent global asymmetry and axial trunk rotation indices were relatively robust to changes in arm posture, both in terms of mean values and withinsubject variations, and also showed a good reliability. Computing measurements from cross-sectional analysis enabled a reduction in errors compared to the measurements based on markers' position.Although not yet sensitive enough to detect small changes for monitoring of curve natural progression, trunk surface analysis can help to document the external asymmetry associated with different types of spinal curves as well as the cosmetic improvement obtained after surgical interventions. The anatomical posture is slightly more reliable as it allows a better coverage of the trunk surface by the digitizing system.

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“…Radiology technicians followed standard protocol to obtain this radiograph. This included a 30 9 90-cm left-to-right cassette of the spine and pelvis with the subject in a comfortable standing position, the knees fully extended, and the upper extremities flexed at the elbow with the fists resting on the clavicles [9,15].…”

Section: Methodsmentioning

confidence: 99%

Assessment of lumbosacral kyphosis in spondylolisthesis: a computer-assisted reliability study of six measurement techniques

et al. 2008

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Although recognized as an important aspect in the management of spondylolisthesis, there is no consensus on the most reliable and optimal measure of lumbosacral kyphosis (LSK). Using a custom computer software, four raters evaluated 60 standing lateral radiographs of the lumbosacral spine during two sessions at a 1-week interval. The sample size consisted of 20 normal, 20 low and 20 high grade spondylolisthetic subjects. Six parameters were included for analysis: Boxall's slip angle, Dubousset's lumbosacral angle (LSA), the Spinal Deformity Study Group's (SDSG) LSA, dysplastic SDSG LSA, sagittal rotation (SR), kyphotic Cobb angle (k-Cobb). Intra-and inter-rater reliability for all parameters was assessed using intra-class correlation coefficients (ICC). Correlations between parameters and slip percentage were evaluated with Pearson coefficients. The intra-rater ICC's for all the parameters ranged between 0.81 and 0.97 and the interrater ICC's were between 0.74 and 0.98. All parameters except sagittal rotation showed a medium to large correlation with slip percentage. Dubousset's LSA and the k-Cobb showed the largest correlations (r = -0.78 and r = -0.50, respectively). SR was associated with the weakest correlation (r = -0.10). All other parameters had medium correlations with percent slip (r = 0.31-0.43). All measurement techniques provided excellent inter-and intra-rater reliability. Dubousset's LSA showed the strongest correlation with slip grade. This parameter can be used in the clinical setting with PACS software capabilities to assess LSK. A computer-assisted technique is recommended in order to increase the reliability of the measurement of LSK in spondylolisthesis.

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Is There an Optimal Patient Stance for Obtaining a Lateral 36” Radiograph?

Cited by 292 publications

References 26 publications

Influence of spinal sagittal alignment, body balance, muscle strength, and physical ability on falling of middle-aged and elderly males

Influence of spinal sagittal alignment, body balance, muscle strength, and physical ability on falling of middle-aged and elderly males

Reliability of trunk shape measurements based on 3-D surface reconstructions

Assessment of lumbosacral kyphosis in spondylolisthesis: a computer-assisted reliability study of six measurement techniques

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