Skip to main content
Erschienen in: Archives of Orthopaedic and Trauma Surgery 12/2010

01.12.2010 | Trauma Surgery

Inter- and intra-observer reliability of the Cobb angle in the measurement of vertebral, local and segmental kyphosis of traumatic lumbar spine fractures in the lateral X-ray

Erschienen in: Archives of Orthopaedic and Trauma Surgery | Ausgabe 12/2010

Einloggen, um Zugang zu erhalten

Abstract

Introduction

Measurement of the vertebral, local and segmental kyphosis according to Cobb is a standard procedure in the assessment of traumatic, idiopathic and degenerative spinal deformities. The purpose of this study was to evaluate the inter- and intra-observer reliability of these three radiological angles on the basis of lateral X-rays in lumbar spine fractures with spinal kyphosis.

Patients and methods

A consecutive series of 88 patients with traumatic lumbar spine fractures with kyphotic deformities were included in the study. All patients were younger that 50 years of age and had an adequate trauma leading to the fracture. Three independent observers with different levels of clinical training measured the vertebral, segmental and local kyphosis of these patients on the basis of lateral X-rays. The readings were repeated 4 weeks later to assess intra-observer reliability.

Results

The most common injury mechanism was a fall from a height of more than 3 m. The first lumbar vertebra was the most commonly affected. Mean inter- and intra-observer reliabilities were good for the vertebral (mean ICC: 0.6607; mean ICC: 0.6979) and local (mean ICC: 0.7778; mean ICC: 0.7642) kyphosis and excellent (mean ICC: 0.8129; mean ICC: 0.8103) for the segmental kyphosis.

Conclusion

In this study, the segmental-, vertebral-, and local kyphosis angle according to Cobb showed sufficient inter- and intra-observer reliability for the use in daily practice and scientific studies.
Literatur
1.
Zurück zum Zitat Cybulski GR, Douglas RA, Meyer PR Jr, Rovin RA (1992) Complications in three-column cervical spine injuries requiring anterior–posterior stabilization. Spine 17(3):253–256CrossRefPubMed Cybulski GR, Douglas RA, Meyer PR Jr, Rovin RA (1992) Complications in three-column cervical spine injuries requiring anterior–posterior stabilization. Spine 17(3):253–256CrossRefPubMed
2.
Zurück zum Zitat Farcy JP, Weidenbaum M, Glassman SD (1990) Sagittal index in management of thoracolumbar burst fractures. Spine 15(9):958–965CrossRefPubMed Farcy JP, Weidenbaum M, Glassman SD (1990) Sagittal index in management of thoracolumbar burst fractures. Spine 15(9):958–965CrossRefPubMed
3.
Zurück zum Zitat Denis F, Armstrong GW, Searls K, Matta L (1984) Acute thoracolumbar burst fractures in the absence of neurologic deficit. A comparison between operative and nonoperative treatment. Clin Orthop Relat Res 189:142–149PubMed Denis F, Armstrong GW, Searls K, Matta L (1984) Acute thoracolumbar burst fractures in the absence of neurologic deficit. A comparison between operative and nonoperative treatment. Clin Orthop Relat Res 189:142–149PubMed
4.
Zurück zum Zitat Gertzbein SD (1994) Neurologic deterioration in patients with thoracic and lumbar fractures after admission to the hospital. Spine 19(15):1723–1725CrossRefPubMed Gertzbein SD (1994) Neurologic deterioration in patients with thoracic and lumbar fractures after admission to the hospital. Spine 19(15):1723–1725CrossRefPubMed
5.
Zurück zum Zitat Hertlein H, Hartl WH, Dienemann H, Schurmann M, Lob G (1995) Thoracoscopic repair of thoracic spine trauma. Eur Spine J 4(5):302–307CrossRefPubMed Hertlein H, Hartl WH, Dienemann H, Schurmann M, Lob G (1995) Thoracoscopic repair of thoracic spine trauma. Eur Spine J 4(5):302–307CrossRefPubMed
6.
Zurück zum Zitat Stotts AK, Smith JT, Santora SD, Roach JW, D’Astous JL (2002) Measurement of spinal kyphosis: implications for the management of Scheuermann’s kyphosis. Spine 27(19):2143–2146CrossRefPubMed Stotts AK, Smith JT, Santora SD, Roach JW, D’Astous JL (2002) Measurement of spinal kyphosis: implications for the management of Scheuermann’s kyphosis. Spine 27(19):2143–2146CrossRefPubMed
7.
Zurück zum Zitat Cobb J (1948) Outline for the study of scoliosis. Am Acad Orthop Surg Instr Course Lect 5:261–275 Cobb J (1948) Outline for the study of scoliosis. Am Acad Orthop Surg Instr Course Lect 5:261–275
8.
Zurück zum Zitat Böhler J (1971) Conservative treatment of thoracic and lumbar spine fractures. Z Unfallmed Berufskr 2:100–104 Böhler J (1971) Conservative treatment of thoracic and lumbar spine fractures. Z Unfallmed Berufskr 2:100–104
9.
Zurück zum Zitat Goutallier D, Louis R (1977) Therapeutic indications in unstable fractures of the spine. Rev Chir Orthop Reparatrice Appar Mot 63(5):475–481PubMed Goutallier D, Louis R (1977) Therapeutic indications in unstable fractures of the spine. Rev Chir Orthop Reparatrice Appar Mot 63(5):475–481PubMed
10.
Zurück zum Zitat Trojan E (1972) Long-term results of 200 vertebral fractures of the thoracic and lumbar spine without paralysis. Z Unfallmed Berufskr 65(2):122–134PubMed Trojan E (1972) Long-term results of 200 vertebral fractures of the thoracic and lumbar spine without paralysis. Z Unfallmed Berufskr 65(2):122–134PubMed
11.
Zurück zum Zitat McLain RF, Sparling E, Benson DR (1993) Early failure of short-segment pedicle instrumentation for thoraco-lumbar fractures. J Bone Joint Surg Am 75:162–169PubMed McLain RF, Sparling E, Benson DR (1993) Early failure of short-segment pedicle instrumentation for thoraco-lumbar fractures. J Bone Joint Surg Am 75:162–169PubMed
12.
Zurück zum Zitat Gebhard F, Schultheiss M (2009) Surgical treatment of fractures of the lumbar spine, vol 1. Steinkopff, Darmstatt, pp 129–136 Gebhard F, Schultheiss M (2009) Surgical treatment of fractures of the lumbar spine, vol 1. Steinkopff, Darmstatt, pp 129–136
13.
Zurück zum Zitat Gstoettner M, Sekyra K, Walochnik N, Winter P, Wachter R, Bach CM (2007) Inter- and intra-observer reliability assessment of the Cobb angle: manual versus digital measurement tools. Eur Spine J 16(10):1587–1592CrossRefPubMed Gstoettner M, Sekyra K, Walochnik N, Winter P, Wachter R, Bach CM (2007) Inter- and intra-observer reliability assessment of the Cobb angle: manual versus digital measurement tools. Eur Spine J 16(10):1587–1592CrossRefPubMed
14.
Zurück zum Zitat Sutherland CJ, Miller F, Wang GJ (1983) Early progressive kyphosis following compression fractures. Two case reports from a series of “stable” thoracolumbar compression fractures. Clin Orthop Relat Res 173:216–220PubMed Sutherland CJ, Miller F, Wang GJ (1983) Early progressive kyphosis following compression fractures. Two case reports from a series of “stable” thoracolumbar compression fractures. Clin Orthop Relat Res 173:216–220PubMed
15.
Zurück zum Zitat Tayyab NA, Samartzis D, Altiok H, Shuff CE, Lubicky JP, Herman J, Khanna N (2007) The reliability and diagnostic value of radiographic criteria in sagittal spine deformities: comparison of the vertebral wedge ratio to the segmental Cobb angle. Spine 32(16):E451–E459CrossRefPubMed Tayyab NA, Samartzis D, Altiok H, Shuff CE, Lubicky JP, Herman J, Khanna N (2007) The reliability and diagnostic value of radiographic criteria in sagittal spine deformities: comparison of the vertebral wedge ratio to the segmental Cobb angle. Spine 32(16):E451–E459CrossRefPubMed
16.
Zurück zum Zitat Tribus CB (1998) Scheuermann’s kyphosis in adolescents and adults: diagnosis and management. J Am Acad Orthop Surg 6(1):36–43PubMed Tribus CB (1998) Scheuermann’s kyphosis in adolescents and adults: diagnosis and management. J Am Acad Orthop Surg 6(1):36–43PubMed
17.
Zurück zum Zitat Ulmar B, Richter M, Kelsch G, Cakir B, Puhl W, Huch K (2005) Distractible vertebral body replacement for the thoracic and lumbar spine. Acta Orthop Belg 71(4):467–471PubMed Ulmar B, Richter M, Kelsch G, Cakir B, Puhl W, Huch K (2005) Distractible vertebral body replacement for the thoracic and lumbar spine. Acta Orthop Belg 71(4):467–471PubMed
18.
Zurück zum Zitat Voutsinas SA, MacEwen GD (1986) Sagittal profiles of the spine. Clin Orthop Relat Res 210:235–242PubMed Voutsinas SA, MacEwen GD (1986) Sagittal profiles of the spine. Clin Orthop Relat Res 210:235–242PubMed
19.
Zurück zum Zitat Briggs AM, Wrigley TV, Tully EA, Adams PE, Greig AM, Bennell KL (2007) Radiographic measures of thoracic kyphosis in osteoporosis: Cobb and vertebral centroid angles. Skeletal Radiol 36(8):761–767CrossRefPubMed Briggs AM, Wrigley TV, Tully EA, Adams PE, Greig AM, Bennell KL (2007) Radiographic measures of thoracic kyphosis in osteoporosis: Cobb and vertebral centroid angles. Skeletal Radiol 36(8):761–767CrossRefPubMed
20.
Zurück zum Zitat Carman DL, Browne RH, Birch JG (1990) Measurement of scoliosis and kyphosis radiographs. Intraobserver and interobserver variation. J Bone Joint Surg Am 72(3):328–333PubMed Carman DL, Browne RH, Birch JG (1990) Measurement of scoliosis and kyphosis radiographs. Intraobserver and interobserver variation. J Bone Joint Surg Am 72(3):328–333PubMed
21.
Zurück zum Zitat Hicks GE, George SZ, Nevitt MA, Cauley JA, Vogt MT (2006) Measurement of lumbar lordosis: inter-rater reliability, minimum detectable change and longitudinal variation. J Spinal Disord Tech 19(7):501–506CrossRefPubMed Hicks GE, George SZ, Nevitt MA, Cauley JA, Vogt MT (2006) Measurement of lumbar lordosis: inter-rater reliability, minimum detectable change and longitudinal variation. J Spinal Disord Tech 19(7):501–506CrossRefPubMed
22.
Zurück zum Zitat Lee SW, Hong JT, Son BC, Sung JH, Kim IS, Park CK (2007) Analysis of accuracy of kyphotic angle measurement for vertebral osteoporotic compression fractures. J Clin Neurosci 14(10):961–965CrossRefPubMed Lee SW, Hong JT, Son BC, Sung JH, Kim IS, Park CK (2007) Analysis of accuracy of kyphotic angle measurement for vertebral osteoporotic compression fractures. J Clin Neurosci 14(10):961–965CrossRefPubMed
23.
Zurück zum Zitat Magerl F, Aebi M, Gertzbein SD, Harms J, Nazarian S (1994) A comprehensive classification of thoracic and lumbar injuries. Eur Spine J 3(4):184–201CrossRefPubMed Magerl F, Aebi M, Gertzbein SD, Harms J, Nazarian S (1994) A comprehensive classification of thoracic and lumbar injuries. Eur Spine J 3(4):184–201CrossRefPubMed
24.
Zurück zum Zitat Pfleischifter J (2006) Evidenzbasierte Konsensus Leitlinie zur Osteoporose. Prophylaxe, Diagnostik und Therapie bei Frauen ab der Menopause, bei Männern ab dem 60. Lebensjahr. Schattauer Verlag, Stuttgart, pp 1–343 Pfleischifter J (2006) Evidenzbasierte Konsensus Leitlinie zur Osteoporose. Prophylaxe, Diagnostik und Therapie bei Frauen ab der Menopause, bei Männern ab dem 60. Lebensjahr. Schattauer Verlag, Stuttgart, pp 1–343
25.
Zurück zum Zitat Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33(1):159–174CrossRefPubMed Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33(1):159–174CrossRefPubMed
26.
Zurück zum Zitat McAfee PC, Yuan HA, Fredrickson BE, Lubicky JP (1983) The value of computed tomography in thoracolumbar fractures. An analysis of one hundred consecutive cases and a new classification. J Bone Joint Surg Am 65(4):461–473PubMed McAfee PC, Yuan HA, Fredrickson BE, Lubicky JP (1983) The value of computed tomography in thoracolumbar fractures. An analysis of one hundred consecutive cases and a new classification. J Bone Joint Surg Am 65(4):461–473PubMed
27.
Zurück zum Zitat Harrison DE, Cailliet R, Harrison DD, Janik TJ, Holland B (2001) Reliability of centroid, Cobb, and Harrison posterior tangent methods: which to choose for analysis of thoracic kyphosis. Spine 26(11):E227–E234CrossRefPubMed Harrison DE, Cailliet R, Harrison DD, Janik TJ, Holland B (2001) Reliability of centroid, Cobb, and Harrison posterior tangent methods: which to choose for analysis of thoracic kyphosis. Spine 26(11):E227–E234CrossRefPubMed
28.
Zurück zum Zitat Morrissy RT, Goldsmith GS, Hall EC, Kehl D, Cowie GH (1990) Measurement of the Cobb angle on radiographs of patients who have scoliosis. Evaluation of intrinsic error. J Bone Joint Surg Am 72(3):320–327PubMed Morrissy RT, Goldsmith GS, Hall EC, Kehl D, Cowie GH (1990) Measurement of the Cobb angle on radiographs of patients who have scoliosis. Evaluation of intrinsic error. J Bone Joint Surg Am 72(3):320–327PubMed
29.
Zurück zum Zitat Polly DW Jr, Kilkelly FX, McHale KA, Asplund LM, Mulligan M, Chang AS (1996) Measurement of lumbar lordosis. Evaluation of intraobserver, interobserver, and technique variability. Spine 21(13):1530–1535 discussion 5–6CrossRefPubMed Polly DW Jr, Kilkelly FX, McHale KA, Asplund LM, Mulligan M, Chang AS (1996) Measurement of lumbar lordosis. Evaluation of intraobserver, interobserver, and technique variability. Spine 21(13):1530–1535 discussion 5–6CrossRefPubMed
30.
Zurück zum Zitat Kuklo TR, Polly DW, Owens BD, Zeidman SM, Chang AS, Klemme WR (2001) Measurement of thoracic and lumbar fracture kyphosis: evaluation of intraobserver, interobserver, and technique variability. Spine 26(1):61–65 discussion 6CrossRefPubMed Kuklo TR, Polly DW, Owens BD, Zeidman SM, Chang AS, Klemme WR (2001) Measurement of thoracic and lumbar fracture kyphosis: evaluation of intraobserver, interobserver, and technique variability. Spine 26(1):61–65 discussion 6CrossRefPubMed
31.
Zurück zum Zitat Seel EH, Verrill CL, Mehta RL, Davies EM (2005) Measurement of fracture kyphosis with the Oxford Cobbometer: intra- and interobserver reliabilities and comparison with other techniques. Spine 30(8):964–968CrossRefPubMed Seel EH, Verrill CL, Mehta RL, Davies EM (2005) Measurement of fracture kyphosis with the Oxford Cobbometer: intra- and interobserver reliabilities and comparison with other techniques. Spine 30(8):964–968CrossRefPubMed
Metadaten
Titel
Inter- and intra-observer reliability of the Cobb angle in the measurement of vertebral, local and segmental kyphosis of traumatic lumbar spine fractures in the lateral X-ray
Publikationsdatum
01.12.2010
Erschienen in
Archives of Orthopaedic and Trauma Surgery / Ausgabe 12/2010
Print ISSN: 0936-8051
Elektronische ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-010-1104-5

Weitere Artikel der Ausgabe 12/2010

Archives of Orthopaedic and Trauma Surgery 12/2010 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Knie-TEP: Kein Vorteil durch antibiotikahaltigen Knochenzement

29.05.2024 Periprothetische Infektionen Nachrichten

Zur Zementierung einer Knie-TEP wird in Deutschland zu über 98% Knochenzement verwendet, der mit einem Antibiotikum beladen ist. Ob er wirklich besser ist als Zement ohne Antibiotikum, kann laut Registerdaten bezweifelt werden.

Häusliche Gewalt in der orthopädischen Notaufnahme oft nicht erkannt

28.05.2024 Häusliche Gewalt Nachrichten

In der Notaufnahme wird die Chance, Opfer von häuslicher Gewalt zu identifizieren, von Orthopäden und Orthopädinnen offenbar zu wenig genutzt. Darauf deuten die Ergebnisse einer Fragebogenstudie an der Sahlgrenska-Universität in Schweden hin.

Fehlerkultur in der Medizin – Offenheit zählt!

28.05.2024 Fehlerkultur Podcast

Darüber reden und aus Fehlern lernen, sollte das Motto in der Medizin lauten. Und zwar nicht nur im Sinne der Patientensicherheit. Eine negative Fehlerkultur kann auch die Behandelnden ernsthaft krank machen, warnt Prof. Dr. Reinhard Strametz. Ein Plädoyer und ein Leitfaden für den offenen Umgang mit kritischen Ereignissen in Medizin und Pflege.

Mehr Frauen im OP – weniger postoperative Komplikationen

21.05.2024 Allgemeine Chirurgie Nachrichten

Ein Frauenanteil von mindestens einem Drittel im ärztlichen Op.-Team war in einer großen retrospektiven Studie aus Kanada mit einer signifikanten Reduktion der postoperativen Morbidität assoziiert.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.