Schuler Thomas C, Subach Brian R, Branch Charles L, Foley Kevin T, Burkus J Kenneth
Virginia Spine Institute, Reston, Virginia 20190, USA.
J Spinal Disord Tech. 2004 Oct;17(5):372-9. doi: 10.1097/01.bsd.0000109836.59382.47.
Obliteration of end-plate landmarks by interbody fusion has made the traditional measurement of segmental lumbar lordosis nearly impossible. Because the L4-L5 and L5-S1 levels are most likely to be subjected to fusion procedures or arthroplasty and contribute to more than half of normal lumbar lordosis, it is crucial to identify a reproducible and accurate means of measuring segmental lordosis at these levels.
Twelve spinal surgeons measured lordosis at L4-L5 and L5-S1 on 10 separate radiographs using three techniques for L4-L5 and four techniques for L5-S1. With use of identical radiographs, measurements first were made using a manual method and then were repeated with a computer-assisted method. Measurements were analyzed for both intraobserver and interobserver error.
The individual data demonstrated an intraobserver variance of 9.56 and a standard deviation of 3.092 for computerized measurements compared with 7.742 and 2.782 for manual measurements. The interobserver variance was 4.107 with a standard deviation of 2.027 for the computerized group compared with 4.221 and 2.055 for manual measurements. When analyzed as a group to evaluate interobserver error, the pooled data yielded variance of 19.235 for the computerized group and 19.117 for the manual measurements.
Variance calculations identified the Cobb technique and the posterior vertebral body technique as the least variable measurement techniques for the L4-L5 and L5-S1 levels, respectively; however, there was no statistical significance. In direct comparison, the manual and computer-assisted techniques were found to be statistically equivalent with similar degrees of variance. We believe that the anterior vertebral technique, which did not demonstrate a significant difference from other techniques, will prove to be the most reliable method of assessing segmental lumbar lordosis in patients before surgery, after interbody fusion, and after motion-sparing disc arthroplasty.
椎间融合导致终板标志消失，使得传统的节段性腰椎前凸测量几乎无法进行。由于L4-L5和L5-S1节段最有可能接受融合手术或关节成形术，且占正常腰椎前凸的一半以上，因此确定一种可重复且准确的方法来测量这些节段的节段性前凸至关重要。
12名脊柱外科医生使用3种L4-L5测量技术和4种L5-S1测量技术，在10张不同的X线片上测量L4-L5和L5-S1的前凸。使用相同的X线片，首先采用手动方法进行测量，然后使用计算机辅助方法重复测量。分析测量结果的观察者内误差和观察者间误差。
个体数据显示，计算机测量的观察者内方差为9.56，标准差为3.092，而手动测量的观察者内方差为7.742，标准差为2.782。计算机测量组的观察者间方差为4.107，标准差为2.027，而手动测量的观察者间方差为4.221，标准差为2.055。将数据作为一个整体进行分析以评估观察者间误差时，计算机测量组的合并方差为19.235，手动测量的合并方差为19.117。
方差计算表明，Cobb技术和椎体后缘技术分别是L4-L5和L5-S1节段测量中变异性最小的技术；然而，差异无统计学意义。直接比较发现，手动和计算机辅助技术在统计学上等效，方差程度相似。我们认为，椎体前缘技术与其他技术相比无显著差异，将被证明是评估患者术前、椎间融合术后和保留运动的椎间盘置换术后节段性腰椎前凸最可靠的方法。
Zotero 插件