Comparison between methods of assessing lumbosacral curve obtained by radiographic image

Vacari, Daiane Aparecida; Neves, Eduardo Borba; Ulbricht, Leandra

doi:10.1590/1413-78522015230200840

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Acta Ortopédica Brasileira

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Original Articles • Acta ortop. bras. 23 (2) • 2015 • https://doi.org/10.1590/1413-78522015230200840 copy

Comparison between methods of assessing lumbosacral curve obtained by radiographic image

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE:

To investigate the correlation between different radiographic methods in the evaluation of the lumbosacral concavity.

METHODS:

The sample consisted of 52 individuals with ages ranging from 18 to 28 years old. The procedures related to radiographic image collection were carried out in collaboration with a diagnostic imaging center of a hospital in Curitiba, PR, Brazil. The angles of the lumbosacral concavity were evaluated by the following methods: Centroid, Cobb1_L1-S1, Cobb2_L1-L5, Cobb3_L2-S1Cobb4_T12-S1,Posterior Tangent and Trall.

RESULTS:

High correlation coefficients (r ranging from 0.77 to 0.89) were found among variations of the Cobb method. Additionally, we propose a categorical classification of angle values obtained by each method. We also analyzed the influence of the level of the inflection point between the lumbar lordosis and thoracic kyphosis in determining the evaluation method to be used. The inflection point had a higher incidence in the region between the twelfth thoracic vertebra and the first lumbar vertebra (63.5%).

CONCLUSION:

The correlation and agreement between methods vary considerably. Moreover, the thoracolumbar inflection point should be considered when choosing the method of assessing patients.

Level of Evidence I, Diagnostic Study.

Spine; Lumbosacral region; Radiography; Evaluation

Interval	Category
< (M – 2SD)	Far below
(M – 2SD) a (M – 1SD)	Moderately below
(M – 1SD) a (M + 1SD)	Average
(M + 1SD) a (M + 2SD)	Moderately above
> (M + 2SD)	Far above

	Cobb_{2 L1s_L5i}	Cobb_{3 L2s_S1s}	Cobb_{4 T12i_S1s}	Centroide	Posterior _L1xL5	Posterior _L1xS1	Trall
Cobb_{1 L1s_S1s}	0.809**	0.810**	0.893**	0.611**	0.467**	0.548**	0.693**
Cobb_{1 L1s_S1s}	Strong	Strong	Strong	Moderate	Moderate	Moderate	Moderate
Cobb_{2 L1s_L5i}		0.800**	0.820**	0.664**	0.502**	0.603**	0.707**
Cobb_{2 L1s_L5i}		Strong	Strong	Moderate	Moderate	Moderate	Strong
Cobb_{3 L2s_S1s}			0.765**	0.572**	0.444**	0.627**	0.677**
Cobb_{3 L2s_S1s}			Strong	Moderate	Moderate	Moderate	Moderate
Cobb_{4 T12i_S1s}				0.585**	0.451**	0.618**	0.651**
Cobb_{4 T12i_S1s}				Moderate	Moderate	Moderate	Moderate
Centroid					0.493**	0.276*	0.697**
Centroid					Moderate	Weak	Moderate
Posterior _L1xL5						0.631**	0.474**
Posterior _L1xL5						Moderate	Moderate
Posterior _L1xS1							0.360**
Posterior _L1xS1							Weak

Classification	Cobb_{3L2s - S1s}	Cobb_{2L1s - L5i}	Cobb_{1L1s - S1s}	Cobb_{4T12i - S1s}	Centroid	Posterior _L1-L5	Posterior _L1-S1	Trall
Mean	50.38	41.98	55.41	58.14	35.54	29.33	60.52	35.14
Standard deviation	9.83	10.80	10.68	9.59	11.20	9.54	11.64	7.54
Far below	< 30.72	< 20.38	< 34.05	< 38.96	< 13.13	< 10.24	< 37.24	< 20.06
Moderately below	30.72 to 40.55	20.38 to 31.18	34.05 to 44.73	38.96 to 48.55	13.13 to 24.34	10.24 to 19.78	37.24 to 48.88	20.06 to 27.60
Average	40.56 to 60.20	31.19 to 52.78	44.74 to 66.08	48.56 to 67.74	24.35 to 46.74	19.79 to 38.87	48.89 to 72.16	27.61 to 42.68
Moderately above	60.21 to 70.03	52.79 to 63.58	66.09 to 76.76	67.75 to 77.33	46.75 to 57.95	38.88 to 48.42	72.17 to 83.80	42.69 to 50.22
Far above	> 70.03	> 63.58	> 76.76	> 77.33	> 57.95	> 48.42	> 83.80	> 50.22

	Cobb_{2L1 - L5}	Cobb_{3L2 - S1}	Cobb_{4T12 - S1}	Centroid	Posterior _L1-L5	Posterior _L1-S1	Trall
Cobb₁	0.634	0.351	0.491	0.322	0.052	0.366	0.215
Cobb₁	Strong	Acceptable	Moderate	Acceptable	Slight	Acceptable	Acceptable
Cobb₂		0.401	0.545	0.503	0.113	0.344	0.315
Cobb₂		Acceptable	Moderate	Acceptable	Slight	Acceptable	Acceptable
Cobb₃			0.345	0.231	0.198	0.427	0.247
Cobb₃			Acceptable	Acceptable	Slight	Moderate	Acceptable
Cobb₄				0.260	0.159	0.395	0.240
Cobb₄				Acceptable	Slight	Acceptable	Acceptable
Centroid					0.001	0.140	0.241
Centroid					Slight	Slight	Acceptable
Posterior _L1-L5						0.241	0.452
Posterior _L1-L5						Acceptable	Moderate
Posterior _L1-S1							0.033
Posterior _L1-S1							Slight

Vertebra	%	N
T9	1.9	1
T10	3.9	2
T11	9.6	5
T12	38.5	20
L1	25.0	13
L2	21.1	11
Total	100.0	52

Vertebra classification	Indicated methods	Percentage of the sample
Above T12	Trall	15.4%
T12 – L1	Cobb_{4 T12i-S1s}	63.5%
	Cobb_{1 L1s-S1s}
	Cobb_{2 L1s-L5i}
	Posterior _L1-L5
L2	Cobb_{3 L2s-S1s}	21.1%
Below L2	Centroid	0.0%
Total		100.0%

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[1] Correspondence: Rua Marquês do Paraná 418, apto. 104, Água Verde, Curitiba, PR, Brazil. borbaneves@hotmail.com