Segmental lumbar lordosis: manual versus computer-assisted measurement using seven different techniques

Area of Science:

• Spine surgery
• Radiographic measurement techniques
• Lumbar lordosis assessment

Background:

• Interbody fusion obliterates end-plate landmarks, complicating traditional lordosis measurement.
• Accurate measurement of lumbar lordosis at L4-L5 and L5-S1 is critical due to their contribution to overall lordosis and frequent involvement in fusion/arthroplasty.

Purpose of the Study:

• To identify reproducible and accurate methods for measuring segmental lordosis at L4-L5 and L5-S1.
• To compare manual and computer-assisted measurement techniques for intraobserver and interobserver error.

Main Methods:

• Twelve spinal surgeons measured lordosis on 10 radiographs using various techniques.
• Measurements were performed manually and then computer-assisted.
• Intraobserver and interobserver errors were analyzed.

Main Results:

• Both manual and computer-assisted techniques showed similar variances in intraobserver and interobserver measurements.
• The Cobb technique (L4-L5) and posterior vertebral body technique (L5-S1) were least variable, though not statistically significant.
• The anterior vertebral technique showed no significant difference from other methods.

Conclusions:

• Manual and computer-assisted methods for measuring segmental lumbar lordosis are statistically equivalent.
• The anterior vertebral technique is proposed as the most reliable method for assessing segmental lumbar lordosis pre- and post-operatively.
• This technique is valuable for patients undergoing fusion, arthroplasty, or requiring pre-surgical assessment.