Interobserver reproducibility of radiographic evaluation of lumbar spine instability

Reliability of the Biomechanical Assessment of the Sagittal Lumbar Spine and Pelvis on Radiographs Used in Clinical Practice: A Systematic Review of the Literature

Background: Biomechanical analysis of the sagittal alignment of the lumbar spine and pelvis on radiographs is common in clinical practices including chiropractic, physical therapy, scoliosis-related thoraco-lumbo-sacral orthosis (TLSO) management, orthopedics, and neurosurgery. Of specific interest is the assessment of pelvic morphology and the relationship between angle of pelvic incidence, sacral slope, and lumbar lordosis to pain, disability, and clinical treatment of spine conditions. The current state of the literature on the reliability of common methods quantifying these parameters on radiographs is limited. Methods: The objective of this systematic review is to identify and review the available studies on the reliability of different methods of biomechanical analysis of sagittal lumbo-pelvic parameters used in clinical practice. Our review followed the recommendations of the preferred reporting items for systematic reviews and meta-analyses (PRISMA). The design of this systematic review was registered with PROSPERO (CRD42023379873). Results: The search strategy yielded a total of 2387 articles. A total of 1539 articles were screened after deduplication and exclusion by automation tools, leaving 473 full-text articles that were retrieved. After exclusion, 64 articles met the inclusion criteria. The preponderance of the evidence showed good to excellent reliability for biomechanical assessment of sagittal lumbo-pelvic spine alignment. Conclusions: The results of this systematic review of the literature show that sagittal radiographic analysis of spinal biomechanics and alignment of the human lumbo-pelvic spine is a reliable tool for aiding diagnosis and management in clinical settings.

A Clinically Applicable Predictive Score in Lumbar Disc Disease for Formulating a Surgical Plan

STUDY DESIGN

Case control study.

OBJECTIVE

Micro-lumbar discectomy or Interbody fusion procedure are work-horse surgical procedures in management of lumbar disc disease. Spine surgeon in their early years of practice gets confused in choosing ideal surgical plan when dealing with a complex scenario. A clinical score is needed to guide spine surgeons in choosing an optimal surgical plan.

MATERIALS AND METHODS

Study was done with research grant approval from AO Spine. A predictive score was formulated as per hypothesis following a pilot study. Two fellowship trained spine surgeons-one using the score (Group A) and other not using score (Group B-control) treated 40 patients included in their respective group. All patients were analysed preoperatively, post-surgery at 12 months follow-up with Visual analog scale score for back pain, leg pain, Oswestry disability index score, SF-36 score. Change in parameters at 12 months follow-up were analysed statistically. P ≤ .05 was considered statistically significant. Success rate of individual surgeon who managed respective group of patients and Difficulty index of surgeon who managed without using score was evaluated at 12 months follow-up.

RESULTS

Success rate of Group A-surgeon was higher than Group B-surgeon .15% of Group B patients had poor surgical outcome at follow-up. Statistically significant improvement in Group A patients were seen in all 3 evaluated parameters when compared to Group B patients at 12 months of follow-up (P ≤ .05). Difficulty index of surgeon who didn't use the score was 15%.

CONCLUSION

The proposed predictive score comprising all risk factors, can be used by spine surgeons when they are confronted with difficult scenario in decision-making. Accuracy, reliability and validity of the score needs to be evaluated in a larger scale.

LEVEL OF EVIDENCE

Ⅲ.

Reliability Analysis of Vertebral Landmark Labelling on Lumbar Spine X-ray Images

Vertebral landmark labelling on X-ray images is important for objective and quantitative diagnosis. Most studies related to the reliability of labelling focus on the Cobb angle, and it is difficult to find studies describing landmark point locations. Since points are the most fundamental geometric feature that can generate lines and angles, the assessment of landmark point locations is essential. The aim of this study is to provide a reliability analysis of landmark points and vertebral endplate lines with a large number of lumbar spine X-ray images. A total of 1000 pairs of anteroposterior and lateral view lumbar spine images were prepared, and 12 manual medicine experts participated in the labelling process as raters. A standard operating procedure (SOP) was proposed by consensus of the raters based on manual medicine and provided guidelines for reducing sources of error in landmark labelling. High intraclass correlation coefficients ranging from 0.934 to 0.991 verified the reliability of the labelling process using the proposed SOP. We also presented means and standard deviations of measurement errors, which could be a valuable reference for evaluating both automated landmark detection algorithms and manual labelling by experts.

Intermodal Detection of Lumbar Instability in Degenerative Spondylolisthesis is Superior to Functional Radiographs

Purpose

In this study, we compare different imaging modalities to find the most sensitive and efficient way of detecting instability in lumbar spondylolisthesis.

Methods

Patients presenting with spondylolisthesis from June 01, 2018 to May 31, 2020 with functional radiographs and either CT scans or MRI images were included in our single-center retrospective cohort study. The amount of translation, in millimeters, was measured on supine MRI images, CT scans, and radiographs of inclination while sitting, standing, or prone and reclination while standing using the Meyerding technique. The amount of translation was compared among the different modalities.

Results

A total of 113 patients with spondylolisthesis on 125 vertebral levels were included in this study. The mean patient age was 73.52 ± 12.59 years; 69 (60.5%) patients were females. The most affected level was L4/5 (62.4%), followed by L3/4 (16%) and L5/S1 (13.6%). The average translations measured on supine CT were 4.13 ± 5.93 mm and 4.42 ± 3.49 mm on MRI (p = 0.3 for the difference between MRI and CT). The difference of inclination while sitting radiograph to slice imaging was 3.37 ± 3.64 mm (p < 0.0001), inclination while standing to slice imaging was 2.67 ± 3.03 mm (p < 0.0001), reclination while standing to slice imaging was 1.6 ± 3.15 mm (p = 0.03), and prone to slice imaging was 2.19 ± 3.02 mm (p = 0.03).

Conclusion

We found that a single radiograph in either inclination, reclination, or prone position compared to a CT scan or an MRI image in supine position can detect instability in spondylolisthesis more efficiently than comparison of functional radiographs in any position.

EFFECT OF PHYSICAL TRAINING IN OBESE PATIENTS WITH LOW BACK PAIN: A SYSTEMATIC REVIEW

ABSTRACT Objective: To understand the hypoalgesic effect of exercises in obese patients with low back pain. Methods: From the methodological point of view, this is a systematic review study supported by the PRISMA guidelines (2020). Only clinical trials with defined eligibility criteria were included and the methodological evaluation was carried out using the Risk of Bias 2.0 (RoB 2.0) tool. Results: Four clinical trials were found, which underwent an assessment of risk of bias and were mostly categorized as moderate risk of bias or with some concerns. Conclusions: Moderate-intensity interval training (MIIT), high-intensity interval training (HIIT), and total resistance or lumbar spine extension exercises were shown to be effective for pain control, quality of life, and functional performance in obese individuals. On the other hand, the exercises alone did not produce a decrease in body composition. Level of evidence I; Systematic review.