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

J Spinal Disord Tech. 2004 Oct;17(5):372-9. doi: 10.1097/01.bsd.0000109836.59382.47.


Objectives: Obliteration of end-plate landmarks by interbody fusion has made the traditional measurement of segmental lumbar lordosis nearly impossible. Because the L4-L5 and L5-S1 levels are most likely to be subjected to fusion procedures or arthroplasty and contribute to more than half of normal lumbar lordosis, it is crucial to identify a reproducible and accurate means of measuring segmental lordosis at these levels.

Methods: Twelve spinal surgeons measured lordosis at L4-L5 and L5-S1 on 10 separate radiographs using three techniques for L4-L5 and four techniques for L5-S1. With use of identical radiographs, measurements first were made using a manual method and then were repeated with a computer-assisted method. Measurements were analyzed for both intraobserver and interobserver error.

Results: The individual data demonstrated an intraobserver variance of 9.56 and a standard deviation of 3.092 for computerized measurements compared with 7.742 and 2.782 for manual measurements. The interobserver variance was 4.107 with a standard deviation of 2.027 for the computerized group compared with 4.221 and 2.055 for manual measurements. When analyzed as a group to evaluate interobserver error, the pooled data yielded variance of 19.235 for the computerized group and 19.117 for the manual measurements.

Conclusions: Variance calculations identified the Cobb technique and the posterior vertebral body technique as the least variable measurement techniques for the L4-L5 and L5-S1 levels, respectively; however, there was no statistical significance. In direct comparison, the manual and computer-assisted techniques were found to be statistically equivalent with similar degrees of variance. We believe that the anterior vertebral technique, which did not demonstrate a significant difference from other techniques, will prove to be the most reliable method of assessing segmental lumbar lordosis in patients before surgery, after interbody fusion, and after motion-sparing disc arthroplasty.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Artifacts
  • Humans
  • Image Processing, Computer-Assisted / methods*
  • Image Processing, Computer-Assisted / standards
  • Image Processing, Computer-Assisted / statistics & numerical data
  • Intervertebral Disc Displacement / surgery
  • Lordosis / diagnostic imaging*
  • Lordosis / pathology
  • Lordosis / surgery
  • Lumbar Vertebrae / diagnostic imaging*
  • Lumbar Vertebrae / pathology
  • Lumbar Vertebrae / surgery
  • Observer Variation
  • Predictive Value of Tests
  • Radiographic Image Interpretation, Computer-Assisted / methods
  • Radiography / methods*
  • Radiography / standards
  • Radiography / statistics & numerical data
  • Reproducibility of Results
  • Sacrum / anatomy & histology
  • Sacrum / diagnostic imaging
  • Spinal Fusion / standards