Radiographic evaluation of lumbar intervertebral disc height index: an intra and inter-rater agreement and reliability study

Purpose: To evaluate intra- and inter-rater agreement and reliability of seven reported disc height index (DHI) measurement methods on standing lateral X-ray of lumbar spine. Methods: The adult patients who had standing lateral X-ray of lumbar spine were recruited. Seven methods were used to measure DHI of each lumbar intervertebral disc level. Bland and Altman Limits of Agreement (LOA) with standard difference were calculated to examine intra- and inter-rater agreements between two out of seven methods for DHI. Intra-class correlations (ICC) with 95% confidence intervals were calculated to assess intra- and inter-rater reliability. Results: The intra-rater reliability in DHI measurements for 288 participants were ICCs from 0.807 (0.794, 0.812) to 0.922 (0.913, 0.946) by rater 1 (SS) and from 0.827 (0.802, 0.841) to 0.918 (0.806, 0.823) by rater 2 (XC). Method 2, 3, and 5 on all segmental levels had bias (95% CI does not include zero) or/and out of the acceptable cut-off proportion (>50%). A total of 609 outliers in 9174 segmental levels LOA range. Inter-rater reliability was good-to-excellent in all but method 2 (0.736 (0.712, 0.759)) and method 5 (0.634 (0.598, 0.667)). ICCs of related lines to good-to-excellent reliability methods was excellent in all but only indirect line in method 1 and 4 (ICCs lie in the range from 0.8 to 0.9). Conclusion: Following structured protocol, intra- and inter-rater reliability was good-to-excellent for most DHI measurement methods on X-ray. However, in the presence of vertebral rotation, one should exercise caution in using complicated methods to define vertebral landmarks. Keywords: Lumbar disc herniation, discectomy, disc height, disc height index, agreement, reliability.

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A Scoring System for Anterior Longitudinal Ligament Ossification of the Lumbar Spine in Diffuse Idiopathic Skeletal Hyperostosis: Relationship Between the Extent of Ligament Ossification and the Range of Motion

Global Spine Journal ◽

10.1177/2192568221996681 ◽

2021 ◽

pp. 219256822199668

Author(s):

Yusuke Murakami ◽

Tadao Morino ◽

Masayuki Hino ◽

Hiroshi Misaki ◽

Hiroshi Imai ◽

...

Keyword(s):

Lumbar Spine ◽

Intervertebral Disc ◽

Range Of Motion ◽

Scoring System ◽

Diffuse Idiopathic Skeletal Hyperostosis ◽

Disc Height ◽

Rater Reliability ◽

Canal Stenosis ◽

Intervertebral Disc Height ◽

The Relationship

Study Design: Retrospective observational study. Objective: To investigate the relationship between the extent of ligament ossification and the range of motion (ROM) of the lumbar spine and develop a new scoring system. Methods: Forty-three patients (30 men and 13 women) with lumbar spinal canal stenosis who underwent decompression from January to December 2018. Ligament ossification at L1/2 to L5/S was assessed on plain X-ray (Xp) and computed tomography (CT) using a modified Mata scoring system (0 point: no ossification, 1 point: ossification of less than half of the intervertebral disc height, 2 points: ossification of half or more of the intervertebral disc height, 3 points: complete bridging), and the intra-rater and inter-rater reliability of the scoring was assessed. The relationship of the scores with postoperative lumbar ROM was investigated. Result: Intra-rater reliability was high (Cronbach’s α was 0.74 for L5/S on Xp but 0.8 or above for other sections), as was inter-rater reliability (Cronbach’s α was 0.8 or above for all the segments). ROM significantly decreased as the score increased (scores 1 to 2, and 2 to 3). A significant moderate negative correlation was found between the sum of the scores at L1/2-L5/S and the ROM at L1-S (ρ = − 0.4493, P = 0.025). Conclusion: Our scoring system reflects lumbar mobility and is reproducible. It is effective for assessing DISH in fractures and spinal conditions, and monitoring effects on treatment outcomes and changes over time.

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Correlation between lumbar intervertebral disc height and lumbar spine sagittal alignment among asymptomatic Asian young adults

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-018-0737-x ◽

2018 ◽

Vol 13 (1) ◽

Cited By ~ 2

Author(s):

Feng Zhang ◽

Kai Zhang ◽

Hai-Jun Tian ◽

Ai-Min Wu ◽

Xiao-Fei Cheng ◽

...

Keyword(s):

Young Adults ◽

Lumbar Spine ◽

Intervertebral Disc ◽

Sagittal Alignment ◽

Disc Height ◽

Lumbar Intervertebral Disc ◽

Intervertebral Disc Height

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In vivo 3D tomography of the lumbar spine using a twin robotic X-ray system: quantitative and qualitative evaluation of the lumbar neural foramina in supine and upright position

European Radiology ◽

10.1007/s00330-020-07355-x ◽

2020 ◽

Author(s):

Anna L. Falkowski ◽

Balazs K. Kovacs ◽

Robyn M. Benz ◽

Patrick Tobler ◽

Stephan Schön ◽

...

Keyword(s):

Lumbar Spine ◽

Image Quality ◽

Intervertebral Disc ◽

Weight Bearing ◽

Upright Position ◽

Disc Height ◽

X Ray ◽

3D Tomography ◽

Intervertebral Disc Height ◽

Wide Range

Abstract Objectives Supine lumbar spine examinations underestimate body weight effects on neuroforaminal size. Therefore, our purpose was to evaluate size changes of the lumbar neuroforamina using supine and upright 3D tomography and to initially assess image quality compared with computed tomography (CT). Methods The lumbar spines were prospectively scanned in 48 patients in upright (3D tomographic twin robotic X-ray) and supine (30 with 3D tomography, 18 with CT) position. Cross-sectional area (CSA), cranio-caudal (CC), and ventro-dorsal (VD) diameters of foramina were measured by two readers and additionally graded in relation to the intervertebral disc height. Visibility of bone/soft tissue structures and image quality were assessed independently on a 5-point Likert scale for the 18 patients scanned with both modalities. Descriptive statistics, Wilcoxon’s signed-rank test (p < 0.05), and interreader reliability were calculated. Results Neuroforaminal size significantly decreased at all levels for both readers from the supine (normal intervertebral disc height; CSA 1.25 ± 0.32 cm2; CC 1.84 ± 0.24 cm2; VD 0.88 ± 0.16 cm2) to upright position (CSA 1.12 ± 0.34 cm2; CC 1.78 ± 0.24 cm2; VD 0.83 ± 0.16 cm2; each p < 0.001). Decrease in intervertebral disc height correlated with decrease in foraminal size (supine: CSA 0.88 ± 0.34 cm2; CC 1.39 ± 0.33 cm2; VD 0.87 ± 0.26 cm2; upright: CSA 0.83 ± 0.37 cm2, p = 0.010; CC 1.32 ± 0.33 cm2, p = 0.015; VD 0.80 ± 0.21 cm2, p = 0.021). Interreader reliability for area was fair to excellent (0.51–0.89) with a wide range for cranio-caudal (0.32–0.74) and ventro-dorsal (0.03–0.70) distances. Image quality was superior for CT compared with that for 3D tomography (p < 0.001; κ, CT = 0.66–0.92/3D tomography = 0.51–1.00). Conclusions The size of the lumbar foramina is smaller in the upright weight-bearing position compared with that in the supine position. Image quality, especially nerve root delineation, is inferior using 3D tomography compared to CT. Key Points • Weight-bearing examination demonstrates a decrease of the neuroforaminal size. • Patients with higher decrease in intervertebral disc showed a narrower foraminal size. • Image quality is superior with CT compared to 3D tomographic twin robotic X-ray at the lumbar spine.

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