Radiographic measurement reliability of lumbar lordosis in ankylosing spondylitis

Abstract

Introduction Intraobserver and interobserver reliabilities of the several different methods to measure lumbar lordosis have been reported. However, it has not been studied sofar in patients with ankylosing spondylitis (AS). Materials and methods We evaluated the inter and intraobserver reliabilities of six specific measures of global lumbar lordosis in patients with AS. Ninety-one consecutive patients with AS who met the most recently modified New York criteria were enrolled and underwent anteroposterior and lateral radiographs of whole spine. The radiographs were divided into non-ankylosis (no bony bridge in the lumbar spine), incomplete ankylosis (lumbar spines were partially connected by bony bridge) and complete ankylosis groups to evaluate the reliability of the Cobb L1-S1, Cobb L1-L5, centroid, posterior tangent L1-S1, posterior tangent L1-L5, and TRALL methods. Results The radiographs were composed of 39 nonankylosis, 27 incomplete ankylosis and 25 complete ankylosis. Intra-and inter-class correlation coefficients (ICCs) of all six methods were generally high. The ICCs were all C0.77 (excellent) for the six radiographic methods in the combined group. However, a comparison of the ICCs, 95 % confidence intervals and mean absolute difference (MAD) between groups with varying degrees of ankylosis showed that the reliability of the lordosis measurements decreased in proportion to the severity of ankylosis. The Cobb L1-S1, Cobb L1-L5 and posterior tangent L1-S1 method demonstrated higher ICCs for both inter and intraobserver comparisons and the other methods showed lower ICCs in all groups. The intraobserver MAD was similar in the Cobb L1-S1 and Cobb L1-L5 (2.7°-4.3°), but the other methods showed higher intraobserver MAD. Interobserver MAD of Cobb L1-L5 only showed low in all group. Conclusion These results are the first to provide a reliability analysis of different global lumbar lordosis measurement methods in AS. The findings in this study demonstrated that the Cobb L1-L5 method is reliable for measuring the global lumbar lordosis in AS.

Comparison between methods of assessing lumbosacral curve obtained by radiographic image

“…Lee et al . 6 found that the measurement of the posterior tangent angle is more reproducible, because it showed the highest rate of reliability in comparisons to Cobb L1-S1 . In this study, there was a moderate correlation (r = 0.63) between these two methods.…”

“…In these methods, firstly, two dividing lines parallel to the surface of the vertebral bodies are marked, selected in each method and subsequently crossed by two perpendicullar lines, which result in the angles, as shown. 5 , 6 , 9 - 12 ( Figure 2 )…”

“…These facts corroborate the strong correlative evidence also found in this study. 6 The purpose of comparing those Cobb methods emerges from the failure in obtaining radiographic image, because defects such as blurring, granulation, dimming or overlaping organs in the areas studied may compromise the identification of anatomical reference points of the selected test, thus hindering to obtain the correct measurement point.…”

“…Currently, tests like Cobb, Trall, Centroid and Posterior Tangent have such characteristics that demonstrate correlatable results, as showed by the study of Lee et al . 6 …”

“…Statistical inference addressed in most studies is related to the investigation of reliability intra and interevaluaters. 6 Therefore, the motivation of this study was to correlate and verify the agreement between the following methods: Cobb, Centroid, Trall, and Posterior Tangent and to propose a categorical classification of the methods studied.…”