Abstract
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, Cobb1L1-S1, Cobb2L1-L5, Cobb3L2-S1 Cobb4T12-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.
Highlights
Formed by a complex anatomical structure, the lumbosacral spine is a very researched segment in the scientific midst.[1,2] The demands arising from the increasing number of cases related to back pain and affections in the lumbosacral structure are usually from poor posture, and in most cases arising from the lack of adaptation of work positions in labor activities, inactivity or congenital and chronic illnesses[3]
Individuals who had undergone some type of radiographic examination in the last year, participants who were not selected by the evaluation of the orthopedic doctor and women, who were pregnant or nursing were not included in the data collection
The centroid method, used in this study, allows making marks that follow the actual contour of the vertebral bodies, decreasing the negative influence caused by the irregularity of the vertebrae in angular measurements.[5] (Figure 3) From this theory, Chen[13] compared the centroid method, with two tests: CobbL1-L5 and CobbL1-S1
Summary
Formed by a complex anatomical structure, the lumbosacral spine is a very researched segment in the scientific midst.[1,2] The demands arising from the increasing number of cases related to back pain and affections in the lumbosacral structure are usually from poor posture, and in most cases arising from the lack of adaptation of work positions in labor activities, inactivity or congenital and chronic illnesses[3]. In order to prevent the disorders of the lumbosacral spine, the pattern of postural alignment considered optimal should have characteristics of bone muscle, ligament, tendon and joint uniformity, and besides, it should present the proper functioning of the nervous and labyrinthic system.[2] Due to the constant demands of scientific knowledge related to the spine, many techniques have been developed to analyze and diagnose cases of posture abnormalities. Tests like Cobb, Trall, Centroid and Posterior Tangent have such characteristics that demonstrate correlatable results, as showed by the study of Lee et al.[6] statistical investigations between the various existing methods for the measurement of lumbosacral curvature remain restricted. Statistical inference addressed in most studies is related to the investigation of reliability intra and interevaluaters.[6] the motivation of this study was to correlate and verify the agreement between the following methods: Cobb, Centroid, Trall, and Posterior Tangent and to propose a categorical classification of the methods studied
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