Abstract
Axial vertebral rotation (AVR) and Cobb angles are the essential parameters to analyse different types of scoliosis, including adolescent idiopathic scoliosis. The literature shows significant discrepancies in the validity and reliability of AVR measurements taken in radiographic examinations, according to the type of vertebra. This study’s scope evaluated the validity and absolute reliability of thoracic and lumbar vertebrae AVR measurements, using a validated software based on Raimondi’s method in digital X-rays that allowed measurement with minor error when compared with other traditional, manual methods. Twelve independent evaluators measured AVR on the 74 most rotated vertebrae in 42 X-rays with the software on three separate occasions, with one-month intervals. We have obtained a gold standard for the AVR of vertebrae. The validity and reliability of the measurements of the thoracic and lumbar vertebrae were studied separately. Measurements that were performed on lumbar vertebrae were shown to be 3.6 times more valid than those performed on thoracic, and with almost an equal reliability (1.38° ± 1.88° compared to −0.38° ± 1.83°). We can conclude that AVR measurements of the thoracic vertebrae show a more significant Mean Bias Error and a very similar reliability than those of the lumbar vertebrae.
Highlights
Most authors accept adolescent idiopathic scoliosis (AIS) as a three-dimensional deformity involving the axial, sagittal and frontal planes [1]
Axial vertebral rotation (AVR) is defined as the rotation of a vertebra around its longitudinal axis when projected onto the transverse image plane [5]
The results showed that the software with the built-in equation increased the validity 1.7 times, and the absolute reliability 1.9 times of AVR measurements conducted on digital X-rays when compared to Raimondi’s conventional manual measurements [28]
Summary
Most authors accept adolescent idiopathic scoliosis (AIS) as a three-dimensional deformity involving the axial, sagittal and frontal planes [1]. To the best of our knowledge, there is no unanimity on AVR measurements’ validity and reliability on radiographic images, depending on the type of vertebra [6,16,26] These discrepancies could be due to the use of different measurement instruments (e.g., Raimondi, Perdriolle, or Nash & Moe) [14,15,16,21], by the type of imaging media used (conventional radiography, digital X-ray with different characteristics, and others) [27], as well as by the number of observers and measurements, which in some studies leads to a relatively low statistical power [6,16,26,28]. Our study aimed to evaluate the differences in quality (validity and reliability) of AVR measurements of the thoracic and lumbar vertebrae on digital frontal entire-spine radiographs of patients with idiopathic scoliosis, using an improved version of Raimondi’s method which uses validated computer-aided diagnosis (CAD) software, and meets the criteria for absolute validity [35,36]. We hypothesised that the AVR measurements on two-dimensional medical images show a different validity and reliability for the thoracic and lumbar vertebrae, perhaps due to anatomical differences (e.g., size or costal overlap in the thoracic vertebrae)
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