Variability in Flexion Extension Radiographs of the Lumbar Spine: A Comparison of Uncontrolled and Controlled Bending
Variability in Flexion Extension Radiographs of the Lumbar Spine: A Comparison of Uncontrolled and Controlled Bending
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DOI：
10.14444/3020
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发表时间：
2016-01-01
影响因子：
1.6
通讯作者：
Wade, Chip
中科院分区：
文献类型：
--
作者：
Cheng, Boyle;Castellvi, Anthony E.;Wade, Chip
背景下腰痛即使不是就诊的最普遍的原因，也是最普遍的原因之一，但大多数下腰痛患者不能得到明确的诊断。虽然在过去的30年里，成像技术有了很大的进步，但在评估腰椎功能的方法上变化相对较小。目前对腰椎功能评估的护理标准侧重于不受控制的患者定向运动，这会导致患者之间的变异性增加。研究设计109例患者(57例无症状，52例有症状)纳入前瞻性研究。目的比较标准屈曲/伸展X线片(FE)测量腰椎运动时腰椎运动的变异性。这项研究旨在比较同一患者中使用椎体运动分析(VMA)(Ortho Kinematics，Inc.)的FE和受控运动弯曲X光片的研究。每个患者都同意接受透视静态成像以获取FE数据，并接受电影透视成像以获取VMA数据。结果测量变异性由评估109名FE和VMA患者的5名独立观察员评估时，由椎间旋转的平均值和标准差来确定。方法VMA测量用于评估椎间运动的特点是：(1)操作装置，帮助患者在直立和平卧状态下通过标准的腰椎弯曲弧线(70度屈曲/伸展弧线；60度左右弯曲弧线)：(2)弯曲过程中腰椎的视频透视成像(以每秒8帧的速度拍摄图像)；以及(3)图像处理软件，能够在视频-透视图像序列上自动逐帧配准和跟踪椎体，以得出椎间旋转和平移的测量结果。结果与VMA(站立和卧位)相比，FE椎间旋转的测量变异性更大。当比较FE和VMA之间的测量变异性时，结果表明，与FE相比，VMA下的测量变异性降低了26%到46%。这些发现在无症状和有症状的患者中是一致的。结论：目前腰椎功能测试的护理标准使用了无控制的FE和手动数据评估过程。在使用计算机成像过程方面的最新进展有所改善，但是由于弯曲的自选率和位置，患者的弯曲仍然存在可变性。VMA显著降低了椎间旋转测量的变异性。
Background While low back pain is one of the most prevalent, if not the most prevalent reasons for visits to physicians, a majority of patients with low back pain cannot be given a definitive diagnosis. While there have been substantial advances in imaging technologies over the past 30 years, relatively little has changed in the methodologies for evaluating functionality of the lumbar spine. The current standard of care for function assessment of the lumbar spine focuses on uncontrolled patient directed motion which results in increased inter-patient variability. Recent advancements in functional lumbar spine testing utilize controlled bending and computerized imaging evaluation.Purpose To compare the measurement variability of lumbar spine motion when diagnosed using measurements of intervertebral motion taken from standard bending flexion/extension radiographs (FE) between uncontrolled and controlled motion.Study Design One-hundred nine patients (57 asymptomatic, 52 symptomatic) were consented in the prospective investigation. The research was designed to compare studies involving FE to controlled motion bending radiographs using the Vertebral Motion Analysis (VMA), (Ortho Kinematics, Inc) within the same patient. Each patient agreed to undergo fluoroscopic still imaging to capture FE data and to undergo cine fluoroscopic imaging to capture VMA data.Outcome Measures Measurement variability was determined by the mean and standard deviation of intervertebral rotation when evaluated by 5 independent observers evaluating each of the 109 patients FE and VMA. The resulting standard deviation of the intervertebral rotation determinations was used as the measure of variability.Methods The VMA measurements for assessing intervertebral motion were characterized by the use of: (1) a handling device that assists patients through a standard arc of lumbar bending in both an upright and recumbent posture (70 degree flexion/extension arcs; 60 degree left/right bending arcs); (2) video fluoroscopy imaging of the lumbar spine during bending (capturing images at 8 frames per second); and (3) image processing software capable of automatic frame-to-frame registration and tracking of vertebral bodies across the sequence of video-fluoroscopic images to derive measurements of intervertebral rotation and translation. The FE data were assessed from voluntary bending by the patient.Results There was statistical greater measurement variability in intervertebral rotation in FE when compared to VMA (both standing and lying). When comparing measurement variability between FE and VMA, results indicate between a 26% to 46% decrease in measurement variability under VMA compared to FE. These findings are consistent across asymptomatic and symptomatic patients.Conclusions The current standard of care for functional testing of the lumbar spine utilizes uncontrolled FE with a manual data evaluation process. Recent developments in using computerized imaging processes has improved, however there remains variability in patient bending due to the self-selected rate and position of the bending. VMA results in a significant reduction in measurement variability of intervertebral rotation measurements.