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Correlation of examiner judgement and radiological digital pictures in infants with upper cervical spine dysfunction:
Jan Peter1, Miklos Csato2, Inga Paravicini1
1Department of Chiropractic Medicine, Balgrist University Hospital and University of Zurich, Zurich, Switzerland.
Insights
Lateral atlantodental distance measurements in infants show excellent reliability for assessing upper cervical spine dysfunction. However, the standard error of measurement limits detecting subtle asymmetries, suggesting its use as a reproducible finding, not an independent diagnostic marker.
Area of Science:
- Pediatric Radiology
- Orthopedics
- Developmental Pediatrics
Background:
- Assessing upper cervical spine dysfunction in infants is crucial for early intervention.
- Digital radiography offers a modern approach to visualizing infant cervical spine anatomy.
- Understanding the reliability of specific radiographic measurements is key for accurate diagnosis.
Purpose of the Study:
- To evaluate the inter-rater reliability of lateral atlantodental distance (LAD) measurements on infant radiographs.
- To explore the correlation between LAD values and clinical findings in infants with cervical spine issues.
Main Methods:
- Analysis of 72 digital radiographs of the odontoid region in infants (3-12 months).
- Bilateral LAD measurements by three independent raters, assessed for reliability using ICC, SEM, and MDC.
- Logistic regression and ROC analysis to correlate LAD with clinical cervical rotational malposition.
Main Results:
- Excellent inter-rater reliability for LAD measurements (ICC=0.91 for both sides).
- Significant association found: LAD was greater on the side of cervical rotational malposition.
- Right-sided LAD predicted right-sided malposition (OR 1.80), with moderate discriminatory performance (AUC=0.74).
Conclusions:
- LAD measurements are highly reproducible in infants.
- The standard error of measurement (SEM) is relatively large, limiting detection of subtle asymmetries.
- LAD should be considered a reproducible radiographic finding associated with cervical rotational malposition, not a standalone diagnostic tool.
Background:
This study aimed to (1) assess the inter-rater reliability of lateral atlantodental distance measurements in digital open-mouth radiographs of infants with upper cervical spine dysfunction, and (2) investigate correlations between lateral atlantodental distance values and clinical findings.
Methods:
72 digital radiographs of the odontoid region from infants aged 3-12 months were analyzed (Aug 2021-Dec 2023). Lateral atlantodental distance was measured bilaterally by three independent raters. Inter-rater reliability and measurement precision was assessed using intraclass correlation coefficients (ICC), standard error of measurement (SEM), and minimal detectable change (MDC). Side differences were evaluated using paired t-tests. Mean lateral atlantodental distance values were further examined for their association with the clinically assessed side of cervical rotational malposition using logistic regression and receiver operating characteristic (ROC) analysis.
Results:
Inter-rater reliability was excellent for right (ICC=0.91 [95% CI: 0.86 - 0.94]) and left (ICC=0.91 [95% CI: 0.86 - 0.95]). The SEM was 0.62 mm for both sides, the MDC was 1.72 mm (right) and 1.73 mm (left). In infants with left-sided cervical rotational malposition, lateral atlantodental distance was significantly greater on the left side, whereas in infants with right-sided cervical rotational malposition, lateral atlantodental distance was significantly greater on the right side. Right-sided lateral atlantodental distance was a significant predictor of clinically assessed right-sided cervical rotational malposition (OR 1.80, 95% CI 1.14-2.84, P=0.01). ROC analysis demonstrated moderate discriminatory performance (AUC = 0.74), meaning that the model is reasonably capable of distinguishing patients with right-sided cervical rotational malposition from those without.
Conclusions:
Although lateral atlantodental distance measurements showed excellent inter-rater reliability, the SEM was relatively large compared with the small absolute values of the measurements (in millimeters), which limits the ability to detect subtle side-to-side asymmetries. Lateral atlantodental distance should be interpreted as a reproducible radiographic finding associated with cervical rotational malposition rather than as an independent diagnostic marker or pathognomonic sign in infants.
Trial Registration:
ClinicalTrials.gov ID NCT04981782 (28.07.2021).
