European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
-
Meta Analysis
Systematic review of tests to identify the disc, SIJ or facet joint as the source of low back pain.
Clinical practice guidelines state that the tissue source of low back pain cannot be specified in the majority of patients. However, there has been no systematic review of the accuracy of diagnostic tests used to identify the source of low back pain. The aim of this systematic review was therefore to determine the diagnostic accuracy of tests available to clinicians to identify the disc, facet joint or sacroiliac joint (SIJ) as the source of low back pain. ⋯ The results of this review demonstrate that tests do exist that change the probability of the disc or SIJ (but not the facet joint) as the source of low back pain. However, the changes in probability are usually small and at best moderate. The usefulness of these tests in clinical practice, particularly for guiding treatment selection, remains unclear.
-
For several years, digitized small radiographs are used to measure Cobb angle in idiopathic scoliosis. The interobserver and intraobserver Cobb angle measurement variability associated with small radiographs were compared with measurement variability associated with the long-cassette radiographs. Twenty adolescent patients with a double major idiopathic scoliosis had erect full-spine p-A radiographs and Cobb angle measurements performed by eight different observers on a 30 x 90 cm plain-film radiograph and a digitized 14 x 42 cm image. ⋯ In our study, Cobb angle determination was not found to vary significantly with film size. The small film image used for full-spine radiographs in our institution allows manual Cobb angle measurements to be performed. A study is currently conducted in our institution to determine if a computer-assisted measurement method significantly improves Cobb angle measurements reliability in routine practice compared with manual measurements of Cobb angles on small films.
-
Recent studies suggested a predominant role of spinopelvic parameters to explain lumbosacral spondylolisthesis pathogeny. We compare the pelvic incidence and other parameters of sagittal spinopelvic balance in adolescents and young adults with developmental spondylolisthesis to those parameters in a control group of healthy volunteers. We compared the angular parameters of the sagittal balance of the spine in a cohort of 244 patients with a developmental L5-S1 spondylolisthesis with those of a control cohort of 300 healthy volunteers. ⋯ We thus believe that increased lumbar lordosis associated with L5-S1 spondylolisthesis is secondary to the high pelvic incidence and is an important factor causing high shear stresses at the L5-S1 pars interarticularis. However, the "local" sagittal imbalance of the lumbosacral junction is compensated by adjacent mobile segments in the upper lumbar spine, the pelvis orientation and the thoracic spine. The result is not optimal but a satisfactory global sagittal balance of the trunk, even in the most severe grade of slipping.
-
Retrospective radiographic review of surgically treated double major curves (Lenke type 3C) in adolescent idiopathic scoliosis. To evaluate the role of selective posterior thoracic correction and fusion in double major curves with third generation instrumentation and to identify preoperative radiographic parameters that predict postoperative coronal spinal decompensation. Traditionally the surgical treatment of double major curves consists of fusion of both the thoracic and the lumbar curve. ⋯ Ten of 36 patients (28%) with Lenke type 3C adolescent idiopathic scoliosis showed coronal spinal decompensation of more than 2 cm after selective posterior thoracic correction and fusion. Lumbar apical vertebral derotation of less than 40% provided the radiographic prediction of postoperative coronal spinal imbalance. We advise close scrutiny of the transverse plane in the lumbar supine bending film when planning surgical strategy.
-
The objective of this study is to determine the intraobserver and interobserver reliability of end vertebra definition and Cobb angle measurement using printed and digital radiographs of 48 patients with scoliosis. The Cobb angle and the end vertebra were assessed by six observers in 48 patients with scoliosis using printed and digital radiographs. Definition of end vertebra and measurement of the Cobb angle was repeated three times with a 3 week interval. ⋯ Until we develop a proper tri-dimensional measuring system an error is introduced. For the Cobb angle measurement the definition of end vertebrae introduces the main source of error. Digital radiography does not improve the measurement accuracy.