Department of Neurosurgery, Allegheny General Hospital, 420 East North Ave., Suite 302, Pittsburgh, PA 15212, USA.
Department of Neurosurgery, Allegheny General Hospital, 420 East North Ave., Suite 302, Pittsburgh, PA 15212, USA; Department of Neurosurgery, Drexel University College of Medicine, 420 East North Ave., Suite 302, Pittsburgh, PA 15212, USA.
Spine J. 2014 Feb 1;14(2):274-81. doi: 10.1016/j.spinee.2013.10.048. Epub 2013 Nov 13.
Traditional methods for the evaluation of in vivo spine kinematics introduce significant measurement variability. Digital videofluoroscopic techniques coupled with computer-assisted measurements have been shown to reduce such error, as well as provide detailed information about spinal motion otherwise unobtainable by standard roentgenograms. Studies have evaluated the precision of computer-assisted fluoroscopic measurements; however, a formal clinical evaluation and comparison with manual methods is unavailable. Further, it is essential to establish reliability of novel measurements systems compared with standard techniques.
To determine the repeatability and reproducibility of sagittal lumbar intervertebral measurements using a new system for the evaluation of lumbar spine motion.
Reliability evaluation of digitized manual versus computer-assisted measurements of the lumbar spine using motion sequences from a videofluoroscopic technique.
A total of 205 intervertebral levels from 61 patients were retrospectively evaluated in this study.
Coefficient of repeatability (CR), limits of agreement (LOA), intraclass correlation coefficient (ICC; type 3,1), and standard error of measurement.
Intervertebral rotations and translations (IVR and IVT) were each measured twice by three physicians using the KineGraph vertebral motion analysis (VMA) system and twice by three different physicians using a digitized manual technique. Each observer evaluated all images independently. Intra- and interobserver statistics were compiled based on the methods of Bland-Altman (CR, LOA) and Shrout-Fleiss (ICC, standard error of measurement).
The VMA measurements demonstrated substantially more precision compared with the manual technique. Intraobserver measurements were the most reliable, with a CR of 1.53 (manual, 8.28) for IVR, and 2.20 (manual, 11.75) for IVT. The least reliable measurements were interobserver IVR and IVT, with a CR of 2.15 (manual, 9.88) and 3.90 (manual, 12.43), respectively. The ICCs and standard error results followed the same pattern.
The VMA system markedly reduced variability of lumbar intervertebral measurements compared with a digitized manual analysis. Further, computer-assisted fluoroscopic imaging techniques demonstrate precision within the range of computer-assisted X-ray analysis techniques.
传统的评估体内脊柱运动学的方法引入了显著的测量变异性。已经证明，数字荧光透视技术与计算机辅助测量相结合，可以减少这种误差，并提供标准射线照相术无法获得的有关脊柱运动的详细信息。已经评估了计算机辅助荧光透视测量的精度；但是，尚未进行正式的临床评估以及与手动方法的比较。此外，与标准技术相比，建立新测量系统的可靠性至关重要。
使用新的腰椎运动评估系统确定矢状位腰椎椎间测量的重复性和再现性。
使用荧光透视技术的运动序列对腰椎进行数字化手动与计算机辅助测量的可靠性评估。
本研究回顾性评估了 61 名患者的 205 个椎间水平。
重复性系数（CR），一致性界限（LOA），组内相关系数（ICC；3，1 型）和测量标准误差。
三位医生使用 KineGraph 椎体运动分析（VMA）系统和三位不同的医生使用数字化手动技术，分别两次测量每个椎间的旋转和平移（IVR 和 IVT）。每位观察者均独立评估所有图像。根据 Bland-Altman（CR，LOA）和 Shrout-Fleiss（ICC，测量标准误差）方法，汇总了观察者内和观察者间的统计学数据。
与手动技术相比，VMA 测量具有更高的精度。观察者内测量最可靠，IVR 的 CR 为 1.53（手动，8.28），IVT 的 CR 为 2.20（手动，11.75）。最不可靠的测量是观察者间的 IVR 和 IVT，CR 分别为 2.15（手动，9.88）和 3.90（手动，12.43）。ICC 和标准误差结果遵循相同的模式。
与数字化手动分析相比，VMA 系统大大降低了腰椎椎间测量的变异性。此外，计算机辅助荧光透视成像技术在计算机辅助 X 射线分析技术的范围内显示出精度。
