Validation of spinal sagittal alignment with plain radiographs and the Debrunner Kyphometer
Main Article Content
Abstract
Validation of the Debrunner Kyphometer as a clinical non-radiological method for investigating spinal sagittal alignment was compared with standing lateral radiographs. The sample group (n=102) consisted of elite Alpine skiers (n=75) and a non-athletic population (n=27), mean age 17.7 (±1.4) years. Non-radiological and radiological measurements of the spinal sagittal kyphosis and lordosis range of motion were carried out in the erect standing position. Thoracic kyphosis measurements comparing the Debrunner Kyphometer with a radiological standard, showed a good level of agreement and a statistical significance (ICC 0.67, 95% CI: 0.26 to 0.83, p<0.001). Lumbar lordosis measurements showed poor levels of agreement in spite of being statistically significant (ICC 0.33, 95% CI: 0.13 to 0.50, p=0.001). There was no significant difference reported in the spinal alignment between skiers and controls using both radiological and non-radiological methods. Therefore, we conclude that due to the large variation in ranges between both methods, there is a limited value in using the Debrunner Kyphometer as a non-invasive method for the evaluation of spinal sagittal alignment.
Key words: Debrunner Kyphometer, kyphosis, lordosis, radiological, spinal sagittal alignment.
Article Details
How to Cite
TODD, Carl Martin et al.
Validation of spinal sagittal alignment with plain radiographs and the Debrunner Kyphometer.
Medical Research Archives, [S.l.], v. 2, n. 1, aug. 2015.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/319>. Date accessed: 27 dec. 2024.
Keywords
Debrunner Kyphometer, kyphosis, lordosis, radiological, spinal sagittal alignment
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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Barrett E., McCreesh K., Lewis J. (2014). Reliability and validity of non-radiographic methods of thoracic kyphosis measurement: A systematic review. Manual Therapy. 19:10-17.
Berthonnaud E, Dimner J, Roussouly P, Labelle H. (2005). Analysis of the sagittal balance of the spine and pelvis using shape and orientation parameters. J Spine Disord, 18(1):40–47.
Billis EV, Foster NE, Wright CC. (2003). Reproducibility and repeatability: errors of three groups of physiotherapists in locating spinal levels by palpation. Man Ther. 8(4):223e32.
Boesker, E., Moe, J., Winter, R., Koop, S. (2000). A determination of the normal thoracic kyphosis: a roentgengraphic study of 121 normal children. J Pediatr Orthop, 20:796-798.
Brennan, P., McDonnell, S., O’Leary, D. (2004). Increasing film-focus distance (FFD) reduces radiation dose for x-ray examinations. Radiat Prot Dosimetry. 108(3):263-8.
Bridwell, K., Bernhardt, M. (1989). Segmental analysis of the sagittal plane alignment of the normal thoracic and lumbar spines and thoracolumbar junction. Spine, 14:717-721.
Cobb JR. (1948). Outline for the study of scoliosis. Instr Course Lect 5:261–268.
Cil A, Yazici M, Uzumcugil A, Kandemir U, Alanay A, Alanay Y, Acaroglu R, Surat A. (2005). The evolution of sagittal segmental alignment of the spine during childhood. Spine, 30:93-100.
Debrunner H. (1972). das Kyphometer. Z Orthop, 110:389-392.
Descamps, H., Commare, M., Marty, C., Hecquet, J., Duval-Beaupere, G. (1999). Modifications des angles pelviens, don’t l’Incidence pelvinne, au cours de la croissance humaine. Biom Hum et Anthropol, 17:59-63.
Duval-Beaupere, G., Schmidt, C., Cosson, P. (1992). A Barycentre-metric study of sagittal shape and pelvis: the conditions required for an economic standing position. ANN Biomed Eng, 20:451-462.
Ensrud KE, Black DM, Harris F et al. (1997). Correlates of kyphosis in older women. J Am Geriatr Soc, 45:682–687.
Fleiss J. (1986).The Design and Analysis of Clinical Experiments. New York: John Wiley & Sons.
French SD, Green S, Forbes A. (2000). Reliability of chiropractic methods commonly used to detect manipulable lesions in patients with chronic low-back pain. J Manipulative Physiol Ther, 23(4):231e8.
Greendale, G., Nili, N., Huang, M., Seeger, L., Karlamangla, A. (2011). The reliability and validity of three non-radiological measures of thoracic kyphosis and their relations to the standing radiological Cobb angle. Osteoporosis Int, 22:1897-1905.
Hardacker, J., Shuford, R., Capicotto, R., Pryor, P. (1997). Radiographic standing cervical segmental alignment in adult volunteers without neck problems. Spine, 22:1472-1480.
Harrison DE, Cailliet R, Harrison DD et al (2002). Reliability of Centroid, Cobb and Harrison posterior tangent methods: which to choose for analysis of thoracic kyphosis. Spine, 26:E227–E234.
Hellsing E, Reigo T, McWilliam J, Spangfort E. (1987). Cervical and lumbar lordosis and kyphosis in 8, 11 and 15-year-old children. Eur J Orthod, 9:129-138.
Hinman MR. (2004). Interrater reliability of flexicurve postural measures among novice users. J Back Musculoskelet Rehabil, 17(1):33.
Huang MH, Barrett-Connor E, Greendale GA et al. (2006). Hyperkyphotic posture and risk of future osteoporotic fractures: the Rancho Bernardo study. J Bone Miner Res, 21(3):419–423.
Korovessis P, Petsinis G, Papazisis Z, Baikousis A. (2001). Prediction of thoracic kyphosis using the Debrunner kyphometer. J Spinal Disord, 14(1):67e72.
Lind-Johansson C. (1985). Kyfometrmätning av Iändryggen: En reliabilitets-studie, Karolinska Institutet (in Swedish).
Mac-Thiong J., Roussouly P., Bertonnaud E., Guigui. (2010). Sagittal parameters of global balance. Normative values from a prospective cohort of seven hundred and nine white asymptomatic adults. Spine, 22:E1193-E1198.
Mac-Thiong, J., Labelle, H., Bertonnaud, E., Betz, R., Roussouly, P. (2007). Sagittal spinopelvic balance in normal children and adolescents. Eur Spine J, 16:227-234.
Mannion AF, Knecht K, Balaban G, Dvorak J, Grob D. (2004). A new skin-surface device for measuring the curvature and global and segmental ranges of motion of the spine: reliability of measurements and comparison with data reviewed from the literature. Eur Spine J, 13(2):122e36.
O’Haire C, Gibbons P. (2000). Inter-examiner and intra-examiner agreement for assessing sacroiliac anatomical landmarks using palpation and observation: pilot study. Man Ther, 5(1):13e20.
Öhlén G, Aaro S, Bylund P. (1988). The sagittal configuration, and mobility of the spine in idiopathic scoliosis. Spine, 13:413-416.
Öhlén G, Spangfort E, Tingvall C. (1989). Measurement of spinal configuration and mobility with Debrunner’s kyphometer. Spine, 14:580-583.
Öhlén G, Wrednark T, Spangfort E. (1989). Spinal sagittal configuration and mobility related to Low-back pain in the female gymnast. Spine, 8:847-850.
Purser JL, Pieper CF, Branch LG, Duncan PW, Gold DT, McConnell ES, et al. (1999). Reliability of physical performance tests in four different randomized clinical trials. Arch Phys Med Rehabil, 80:557e61.
Roussouly, P., Pinheiro-Franco, J. (2011). Biomechanical analysis of the spino-pelvic organization and adaptation in pathology. Eur Spine J, 20 (Suppl 5):S609–S618.
Roussouly P., Nnadi C. (2010). Sagittal plane deformity: an overview of interpretation and management. Eur Spine J, 19:1824-1836.
Roussouly, P., Gollogly, S., Bertonnaud, E., Dimnet, J. (2005). Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine, 30(3):346-353.
Ripani M, Di Cesare A, Giombini A, Agnello L, Fagnani F, Pigozzi F. (2008). Spinal curvature: comparison of frontal measurements with the spinal mouse and radiographic assessment. J Sports Med Phys Fitness, 48(4): 488e94.
Salisbury PJ, Porter RW. (1987). Measurement of lumbar sagittal mobility. A comparison of methods. Spine, 12:190–193.
Sheeran L, Sparkes V, Busse M, van Deursen R. (2010). Preliminary study: reliability of the spinal wheel. A novel device to measure spinal postures applied to sitting and standing. Eur Spine J, 19(6):995e1003.
Singer KP, Edmondston SJ, Day RE et al. (1994). Computer- assisted curvature assessment and Cobb angle determination of the thoracic kyphosis. Spine, 19:1381–1384.
Stagnara, P., De Mauroy, J., Dran, G., Gonon, G., Costanzo, G., Dimnet, J., Pasquet, A. (1982). Reciprocal angulation of vertebral bodies in a sagittal plane: approach to references for the evaluation of kyphosis and lordosis. Spine, (Phila Pa 1976) 7(4):335-342.
Van Blommestein AS, Lewis AS, Morrissey MC, MacRae S. (2009). Reliability of measuring thoracic kyphosis angle, lumbar lordosis angle and straight leg raise with an inclinometer. Open Spine J, 4:10e5.
Voutsinas S, MacEwen G. (1986). Sagittal profiles of the spine. Clin Orthop, 210:235-242.
Willner S. (1981). Spinal pantograph: a non-invasive technique for describing kyphosis and lordosis in the thoraco-lumbar spine. Acta Orthop Scand, 52:525e9.
Barrett E., McCreesh K., Lewis J. (2014). Reliability and validity of non-radiographic methods of thoracic kyphosis measurement: A systematic review. Manual Therapy. 19:10-17.
Berthonnaud E, Dimner J, Roussouly P, Labelle H. (2005). Analysis of the sagittal balance of the spine and pelvis using shape and orientation parameters. J Spine Disord, 18(1):40–47.
Billis EV, Foster NE, Wright CC. (2003). Reproducibility and repeatability: errors of three groups of physiotherapists in locating spinal levels by palpation. Man Ther. 8(4):223e32.
Boesker, E., Moe, J., Winter, R., Koop, S. (2000). A determination of the normal thoracic kyphosis: a roentgengraphic study of 121 normal children. J Pediatr Orthop, 20:796-798.
Brennan, P., McDonnell, S., O’Leary, D. (2004). Increasing film-focus distance (FFD) reduces radiation dose for x-ray examinations. Radiat Prot Dosimetry. 108(3):263-8.
Bridwell, K., Bernhardt, M. (1989). Segmental analysis of the sagittal plane alignment of the normal thoracic and lumbar spines and thoracolumbar junction. Spine, 14:717-721.
Cobb JR. (1948). Outline for the study of scoliosis. Instr Course Lect 5:261–268.
Cil A, Yazici M, Uzumcugil A, Kandemir U, Alanay A, Alanay Y, Acaroglu R, Surat A. (2005). The evolution of sagittal segmental alignment of the spine during childhood. Spine, 30:93-100.
Debrunner H. (1972). das Kyphometer. Z Orthop, 110:389-392.
Descamps, H., Commare, M., Marty, C., Hecquet, J., Duval-Beaupere, G. (1999). Modifications des angles pelviens, don’t l’Incidence pelvinne, au cours de la croissance humaine. Biom Hum et Anthropol, 17:59-63.
Duval-Beaupere, G., Schmidt, C., Cosson, P. (1992). A Barycentre-metric study of sagittal shape and pelvis: the conditions required for an economic standing position. ANN Biomed Eng, 20:451-462.
Ensrud KE, Black DM, Harris F et al. (1997). Correlates of kyphosis in older women. J Am Geriatr Soc, 45:682–687.
Fleiss J. (1986).The Design and Analysis of Clinical Experiments. New York: John Wiley & Sons.
French SD, Green S, Forbes A. (2000). Reliability of chiropractic methods commonly used to detect manipulable lesions in patients with chronic low-back pain. J Manipulative Physiol Ther, 23(4):231e8.
Greendale, G., Nili, N., Huang, M., Seeger, L., Karlamangla, A. (2011). The reliability and validity of three non-radiological measures of thoracic kyphosis and their relations to the standing radiological Cobb angle. Osteoporosis Int, 22:1897-1905.
Hardacker, J., Shuford, R., Capicotto, R., Pryor, P. (1997). Radiographic standing cervical segmental alignment in adult volunteers without neck problems. Spine, 22:1472-1480.
Harrison DE, Cailliet R, Harrison DD et al (2002). Reliability of Centroid, Cobb and Harrison posterior tangent methods: which to choose for analysis of thoracic kyphosis. Spine, 26:E227–E234.
Hellsing E, Reigo T, McWilliam J, Spangfort E. (1987). Cervical and lumbar lordosis and kyphosis in 8, 11 and 15-year-old children. Eur J Orthod, 9:129-138.
Hinman MR. (2004). Interrater reliability of flexicurve postural measures among novice users. J Back Musculoskelet Rehabil, 17(1):33.
Huang MH, Barrett-Connor E, Greendale GA et al. (2006). Hyperkyphotic posture and risk of future osteoporotic fractures: the Rancho Bernardo study. J Bone Miner Res, 21(3):419–423.
Korovessis P, Petsinis G, Papazisis Z, Baikousis A. (2001). Prediction of thoracic kyphosis using the Debrunner kyphometer. J Spinal Disord, 14(1):67e72.
Lind-Johansson C. (1985). Kyfometrmätning av Iändryggen: En reliabilitets-studie, Karolinska Institutet (in Swedish).
Mac-Thiong J., Roussouly P., Bertonnaud E., Guigui. (2010). Sagittal parameters of global balance. Normative values from a prospective cohort of seven hundred and nine white asymptomatic adults. Spine, 22:E1193-E1198.
Mac-Thiong, J., Labelle, H., Bertonnaud, E., Betz, R., Roussouly, P. (2007). Sagittal spinopelvic balance in normal children and adolescents. Eur Spine J, 16:227-234.
Mannion AF, Knecht K, Balaban G, Dvorak J, Grob D. (2004). A new skin-surface device for measuring the curvature and global and segmental ranges of motion of the spine: reliability of measurements and comparison with data reviewed from the literature. Eur Spine J, 13(2):122e36.
O’Haire C, Gibbons P. (2000). Inter-examiner and intra-examiner agreement for assessing sacroiliac anatomical landmarks using palpation and observation: pilot study. Man Ther, 5(1):13e20.
Öhlén G, Aaro S, Bylund P. (1988). The sagittal configuration, and mobility of the spine in idiopathic scoliosis. Spine, 13:413-416.
Öhlén G, Spangfort E, Tingvall C. (1989). Measurement of spinal configuration and mobility with Debrunner’s kyphometer. Spine, 14:580-583.
Öhlén G, Wrednark T, Spangfort E. (1989). Spinal sagittal configuration and mobility related to Low-back pain in the female gymnast. Spine, 8:847-850.
Purser JL, Pieper CF, Branch LG, Duncan PW, Gold DT, McConnell ES, et al. (1999). Reliability of physical performance tests in four different randomized clinical trials. Arch Phys Med Rehabil, 80:557e61.
Roussouly, P., Pinheiro-Franco, J. (2011). Biomechanical analysis of the spino-pelvic organization and adaptation in pathology. Eur Spine J, 20 (Suppl 5):S609–S618.
Roussouly P., Nnadi C. (2010). Sagittal plane deformity: an overview of interpretation and management. Eur Spine J, 19:1824-1836.
Roussouly, P., Gollogly, S., Bertonnaud, E., Dimnet, J. (2005). Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine, 30(3):346-353.
Ripani M, Di Cesare A, Giombini A, Agnello L, Fagnani F, Pigozzi F. (2008). Spinal curvature: comparison of frontal measurements with the spinal mouse and radiographic assessment. J Sports Med Phys Fitness, 48(4): 488e94.
Salisbury PJ, Porter RW. (1987). Measurement of lumbar sagittal mobility. A comparison of methods. Spine, 12:190–193.
Sheeran L, Sparkes V, Busse M, van Deursen R. (2010). Preliminary study: reliability of the spinal wheel. A novel device to measure spinal postures applied to sitting and standing. Eur Spine J, 19(6):995e1003.
Singer KP, Edmondston SJ, Day RE et al. (1994). Computer- assisted curvature assessment and Cobb angle determination of the thoracic kyphosis. Spine, 19:1381–1384.
Stagnara, P., De Mauroy, J., Dran, G., Gonon, G., Costanzo, G., Dimnet, J., Pasquet, A. (1982). Reciprocal angulation of vertebral bodies in a sagittal plane: approach to references for the evaluation of kyphosis and lordosis. Spine, (Phila Pa 1976) 7(4):335-342.
Van Blommestein AS, Lewis AS, Morrissey MC, MacRae S. (2009). Reliability of measuring thoracic kyphosis angle, lumbar lordosis angle and straight leg raise with an inclinometer. Open Spine J, 4:10e5.
Voutsinas S, MacEwen G. (1986). Sagittal profiles of the spine. Clin Orthop, 210:235-242.
Willner S. (1981). Spinal pantograph: a non-invasive technique for describing kyphosis and lordosis in the thoraco-lumbar spine. Acta Orthop Scand, 52:525e9.