Skip to main content

Advertisement

SpringerLink
Log in

Radiographic measurement of the sagittal plane deformity in patients with osteoporotic spinal fractures evaluation of intrinsic error

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Cobb method has been shown to be the most reliable technique with a reasonable measurement error to determine the kyphosis in fresh fractures of young patients. However, measurement errors may be higher for elderly patients as it may be difficult to determine the landmarks due to osteopenia and the degenerative changes. The aim of this study is to investigate the intrinsic error for different techniques used in evaluation of local sagittal plane deformity caused by OVCF. Lateral X-rays of OVCF patients were randomly selected. Patient group was composed of 28 females and 7 males and the mean age was 62.7 (55–75) years. The kyphosis angle and the vertebral body height were analyzed to reveal the severity of sagittal plane deformity. Kyphotic deformity was measured by using four different techniques; and the vertebral body heights (VBH) were measured at three different points. The mean intra-observer agreement interval for kyphosis angle measurement techniques ranged from ±7.1 to ±9.3° while it ranged from ±4.5 to ±6.5 mm for VBH measurement techniques. The mean interobserver agreement interval for kyphosis angle ranged from ±8.2 to ±11.1°, while it was between ±4.5 to ±6.5 mm for vertebral body height measurement techniques. This study revealed that although the intra and interobserver agreement were similar for all techniques, they are still higher than expected. These high intervals for measurement errors should be taken into account when interpreting the results of correction in local sagittal plane deformities of OVCF patients after surgical procedures such as vertebral augmentation techniques.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Berlemann U, Franz T, Orler R, Heini PF (2004) Kyphoplasty for treatment of osteoporotic vertebral fractures: a prospective non-randomized study. Eur Spine J 13(6):496–501

    Article  PubMed  Google Scholar 

  2. Bland JM, Altman DG (1999) Measuring agreement in method comparison studies. Stat Methods Med Res 8:135–160

    Article  PubMed  CAS  Google Scholar 

  3. Bouza C, Lopez T, Magro A, Navalpotro L, Amate JM (2006) Efficacy and safety of balloon kyphoplasty in the treatment of vertebral compression fractures: a systematic review. Eur Spine J 21:1–18

    Google Scholar 

  4. Cakir B, Richter M, Kafer W, Wieser M, Puhl W, Schmidt R (2006) Evaluation of lumbar spine motion with dynamic X-ray—a reliability analysis. Spine 31(11):1258–1264

    Article  PubMed  Google Scholar 

  5. Carman DL, Browne RH, Birch JG (1990) Measurement of scoliosis and kyphosis radiographs—intraobserver and interobserver variation. J Bone Joint Surg 72-A(3):328–333

    Google Scholar 

  6. Crandall D, Slaughter D, Hankins PJ, Moore C, Jerman J (2004) Acute versus chronic vertebral compression fractures treated with kyphoplasty: early results. Spine J 4(4):418–424

    Article  PubMed  Google Scholar 

  7. Dublin AB, Hartman J, Latchaw RE, Hald JK, Reid MH (2005) The vertebral body fracture in osteoporosis: restoration of height using percutaneous vertebroplasty. AJNR Am J Neuroradiol 26(3):489–492

    PubMed  Google Scholar 

  8. Dudeney S, Lieberman IH, Reinhardt MK, Hussein M (2002) Kyphoplasty in the treatment of osteolytic vertebral compression fractures as a result of multiple myeloma. J Clin Oncol 20(9):2382–2387

    Article  PubMed  CAS  Google Scholar 

  9. Eastell R, Cedel SL, Wahner HW, Riggs BL, Melton LJ 3rd (1991) Classification of vertebral fractures. J Bone Miner Res 6(3):207–215

    Article  PubMed  CAS  Google Scholar 

  10. Fourney DR, Schomer DF, Nader R, Chlan-Fourney J, Suki D, Ahrar K, Rhines LD, Gokaslan ZL (2003) Percutaneous vertebroplasty and kyphoplasty for painful vertebral body fractures in cancer patients. J Neurosurg Spine 98(1):21–30

    Google Scholar 

  11. Gaitanis IN, Hadjipavlou AG, Katonis PG, Tzermiadianos MN, Pasku DS, Patwardhan AG (2005) Balloon kyphoplasty for the treatment of pathological vertebral compressive fractures. Eur Spine J 14(3):250–260

    Article  PubMed  Google Scholar 

  12. Garfin SR, Yuan HA, Reiley MA (2001) New technologies in spine: kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures. Spine 26(14):1511–1515

    Article  PubMed  CAS  Google Scholar 

  13. Hadjipavlou AG, Tzermiadianos MN, Katonis PG, Szpalski M (2005) Percutaneous vertebroplasty and balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures and osteolytic tumours. J Bone Joint Surg Br. 87(12):1595–1604

    Article  PubMed  CAS  Google Scholar 

  14. Heini PF, Orler R (2004) Kyphoplasty for treatment of osteoporotic vertebral fractures. Eur Spine J 13(3):184–192

    Article  PubMed  Google Scholar 

  15. Hiwatashi A, Moritani T, Numaguchi Y, Westesson PL (2003) Increase in vertebral body height after vertebroplasty. AJNR Am J Neuroradiol 24(2):185–189

    PubMed  Google Scholar 

  16. Hulme PA, Krebs J, SJ Ferguson, Berlemann U (2006) Vertebroplasty and kyphoplasty: a systematic review of 69 studies. Spine. 31:1983–2001

    Article  PubMed  Google Scholar 

  17. Kuklo TR, Polly DW, Owens BD, Zeidman SM, Chang AS, Klemme WR (2001) Measurement of thoracic and lumbar fracture kyphosis—evaluation of intraobserver, interobserver and technique variability. Spine 26(1):61–66

    Article  PubMed  CAS  Google Scholar 

  18. Ledlie JT, Renfro M (2003) Balloon kyphoplasty: one-year outcomes in vertebral body height restoration, chronic pain, and activity levels. J Neurosurg Spine 98(1):36–42

    Article  Google Scholar 

  19. Lieberman IH, Dudeney S, Reinhardt MK, Bell G (2001) Initial outcome and efficacy of “kyphoplasty” in the treatment of painful osteoporotic vertebral compression fractures. Spine 26:1631–1638

    Article  PubMed  CAS  Google Scholar 

  20. Lim MR, Loder RT, Huang RC, Lyman S, Zhang K, Sama A, Papadopoulos EC, Warner K, Girardi FP, Cammisa FP Jr (2006) Measurement error of lumbar total disc replacement range of motion. Spine 31(10):E291–E297

    Article  PubMed  Google Scholar 

  21. McKiernan F, Faciszewski T, Jensen R (2003) Reporting height restoration in vertebral compression fractures. Spine 28(22):2517–2521

    Article  PubMed  Google Scholar 

  22. McKiernan F, Jensen R, Faciszewski T (2003) The dynamic mobility of vertebral compression fractures. J Bone Miner Res 18(1):24–29

    Article  PubMed  Google Scholar 

  23. Phillips FM, Ho E, Campbell-Hupp M, McNally T, Todd Wetzel F, Gupta P (2003) Early radiographic and clinical results of balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures. Spine 28(19):2260–2265

    Article  PubMed  Google Scholar 

  24. Pradhan BB, Bae HW, Kropf MA, Patel VV, Delamarter RB (2006) Kyphoplasty reduction of osteoporotic vertebral compression fractures: correction of local kyphosis versus overall sagittal alignment. Spine 31(4):435–441

    Article  PubMed  Google Scholar 

  25. Rao RD, Singrakhia MD (2003) Painful osteoporotic vertebral fracture. Pathogenesis, evaluation, and roles of vertebroplasty and kyphoplasty in its management. J Bone Joint Surg Am 85-A(10):2010–2022

    PubMed  Google Scholar 

  26. Rhyne A 3rd, Banit D, Laxer E, Odum S, Nussman D (2004) Kyphoplasty: report of eighty-two thoracolumbar osteoporotic vertebral fractures. J Orthop Trauma 18(5):294–299

    Article  PubMed  Google Scholar 

  27. Schlaich C, Minne HW, Bruckner T, Wagner G, Gebest HJ, Grunze M, Ziegler R, Leidig-Bruckner G (1998) Reduced pulmonary function in patients with spinal osteoporotic fractures. Osteoporos Int 8:261–267

    Article  PubMed  CAS  Google Scholar 

  28. Shea KG, Stevens PM, Nelson M, Smith JT, Masters KS, Yandow S (1998) A comparison of manual versus computer-assisted radiographic measurement. Intraobserver measurement variability for Cobb angles. Spine 23(5):551–555

    Article  PubMed  CAS  Google Scholar 

  29. Stotts AK, Smith JT, Santora SD, Roach JW, D’Astous JL (2002) Measurement of spinal kyphosis—implications for the management of Scheuermann’s kyphosis. Spine 27(19):2143–2146

    Article  PubMed  Google Scholar 

  30. Teng MM, Wei CJ, Wei LC, Luo CB, Lirng JF, Chang FC, Liu CL, Chang CY (2003) Kyphosis correction and height restoration effects of percutaneous vertebroplasty. AJNR 24(9):1893–1900

    PubMed  Google Scholar 

  31. Theodorou DJ, Theodorou SJ, Duncan TD, Garfin SR, Wong WH (2002) Percutaneous balloon kyphoplasty for the correction of spinal deformity in painful vertebral body compression fractures. Clin Imaging 26(1):1–5

    Article  PubMed  Google Scholar 

  32. Wilhelm K, Stoffel M, Ringel F, Rao G, Rosseler L, Urbach H, Meyer B (2003) Preliminary experience with balloon kyphoplasty for the treatment of painful osteoporotic compression fractures. Rofo 175(12):1690–1696

    PubMed  CAS  Google Scholar 

  33. Voggenreiter G (2005) Balloon kyphoplasty is effective in deformity correction of osteoporotic vertebral compression fractures. Spine 30(24):2806–2812

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Hacettepe University Faculty of Medicine, 06100, Sihhiye, Ankara, Turkey

    Ahmet Alanay, Murat Pekmezci, Emre Acaroglu, Muharrem Yazıcı, Akın Cil & Bas Pijnenburg

  2. Department of Orthopedic Surgery, Baskent University, Ankara, Turkey

    Oguz Karaeminogulları

  3. Department of Biostatistics, School of Medicine, Ankara University, Ankara, Turkey

    Yasemin Genç

  4. Department of Orthopaedic Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands

    Fethullah C. Oner

Authors
  1. Ahmet Alanay
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Murat Pekmezci
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Oguz Karaeminogulları
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Emre Acaroglu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Muharrem Yazıcı
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Akın Cil
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Bas Pijnenburg
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yasemin Genç
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Fethullah C. Oner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ahmet Alanay.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Alanay, A., Pekmezci, M., Karaeminogulları, O. et al. Radiographic measurement of the sagittal plane deformity in patients with osteoporotic spinal fractures evaluation of intrinsic error. Eur Spine J 16, 2126–2132 (2007). https://doi.org/10.1007/s00586-007-0474-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-007-0474-z

Keywords

Search

Navigation