Use of the iPhone for Cobb angle measurement in scoliosis

Purpose

The Cobb technique is the universally accepted method for measuring the severity of spinal deformities. Traditionally, Cobb angles have been measured using protractor and pencil on hardcopy radiographic films. The new generation of mobile ‘smartphones’ make accurate angle measurement possible using an integrated accelerometer, providing a potentially useful clinical tool for assessing Cobb angles. The purpose of this study was to compare Cobb angle measurements performed using a smartphone and traditional protractor in a series of 20 adolescent idiopathic scoliosis patients.

Methods

Seven observers measured major Cobb angles on 20 pre-operative postero-anterior radiographs of Adolescent Idiopathic Scoliosis patients with both a standard protractor and using an Apple iPhone. Five of the observers repeated the measurements at least a week after the original measurements.

Results

The mean absolute difference between pairs of smartphone/protractor measurements was 2.1°, with a small (1°) bias toward lower Cobb angles with the iPhone. 95% confidence intervals for intra-observer variability were ±3.3° for the protractor and ±3.9° for the iPhone. 95% confidence intervals for inter-observer variability were ±8.3° for the iPhone and ±7.1° for the protractor. Both of these confidence intervals were within the range of previously published Cobb measurement studies.

Conclusions

We conclude that the iPhone is an equivalent Cobb measurement tool to the manual protractor, and measurement times are about 15% less. The widespread availability of inclinometer-equipped mobile phones and the ability to store measurements in later versions of the angle measurement software may make these new technologies attractive for clinical measurement applications.     

Operative Therapie der idiopathischen Skoliose mittels ventraler Doppelstabinstrumentation

Background

In the surgical treatment of idiopathic scoliosis both anterior and posterior correction and instrumentation techniques are available. The aim of the present study was to analyse the results of a new anterior dual rod instrumentation.

Patients and methods

Prospective analysis of radiometric and clinical parameters of 93 patients operated on between 1996 and 2004 using the Münster Anterior Dual Rod System.

Results

The average curve correction was 65% (fusion length usually Cobb levels) with a preoperative Cobb angle of 59°. Postoperative loss of correction amounted to 1.5° (average follow-up of 36 months). Apical vertebral derotation averaged 45% in the thoracic and 53% in the lumbar spine with a subsequent correction of the rib hump of 66% and the lumbar hump of 81%. There were no revisions or neurological complications.

Conclusion

Anterior dual rod instrumentation enables an effective and safe three-dimensional curve correction in single structural curves with only minimal loss of correction.     

Factors influencing the residual rib hump after posterior spinal fusion for adolescent idiopathic scoliosis with Lenke 1 and 2 curves

Background

Despite remarkable improvement in Cobb angle after surgery for scoliosis, many patients have a residual rib hump. We studied the factors responsible for this hump and their influence on patient satisfaction.

Methods

We recruited 2 men and 38 women (mean age 14.9 years) who underwent skip pedicle screw fixation combined with direct vertebral body derotation for adolescent idiopathic scoliosis with Lenke type 1 and 2 curves. Hump size was evaluated by measuring apical trunk rotation (ATR). Patients with postoperative ATR ≤10° were categorized as group A and those with postoperative ATR >10° as group B. We analyzed postoperative self-image and satisfaction subscores of the SRS-22 questionnaire. We also compared the rate of postoperative improvement in ATR between patients who underwent additional Ponte osteotomy and those who did not.

Results

Preoperative ATR, preoperative apical translation, and preoperative and postoperative apical rotation significantly differed between groups A and B. In contrast, Cobb angles before and after surgery, Cobb angle correction rates, apical translation after correction, and postoperative self-image and satisfaction scores did not differ significantly between the groups. However, the rate of improvement in ATR showed a strong correlation with self-image (correlation coefficient 0.64) and satisfaction (correlation coefficient 0.52). This improvement rate did not differ significantly between subjects who underwent additional Ponte osteotomy and those who did not.

Conclusions

Preoperative apical rotation and ATR were clearly related to postoperative residual hump. For decreasing the postoperative rib hump, removal of the deformation by apical rotation was considered more important than correction of Cobb angle. Patient satisfaction and self-image scores were not significantly related to postoperative residual hump size, but they were influenced by improvement in ATR.     

Annual changes in radiographic indices of the spine in cerebral palsy patients

Purpose

We estimated the annual changes in radiographic indices of the spine in cerebral palsy (CP) patients and analyzed the factors that influence its progression rate.

Methods

We included CP patients who had undergone whole-spine radiography more than twice and were followed for at least 1 year. The scoliosis Cobb angle, coronal balance, apical vertebral translation, apical rotation, and pelvic obliquity were measured on anteroposterior (AP) radiographs; thoracic kyphosis and lumbar lordosis angles, and sagittal balance was measured on lateral radiographs; and migration percentage was measured on AP hip radiographs to determine hip instability. For each gross motor function classification system (GMFCS) level, the Cobb angles, apical vertebral translation, coronal and sagittal balance, and pelvic obliquity were adjusted by multiple factors with a linear mixed model.

Results

A total of 184 patients (774 radiographs) were included in this study. There was no significant annual change in scoliosis Cobb, thoracic kyphosis, and lumbar lordosis angles in the GMFCS level I–II and III groups. In the GMFCS level IV–V group, there was an annual increase of 3.4° in the scoliosis Cobb angle (p = 0.020). The thoracic kyphosis angle increased by 2.2° (p = 0.018) annually in the GMFCS level IV–V group. Apical vertebral translation increased by 5.4 mm (p = 0.029) annually in the GMFCS level IV–V group. Progression of coronal and sagittal balance and pelvic obliquity with aging were not statistically significant. Sex, hip instability, hip surgery, and triradiate cartilage did not affect the progression of scoliosis and the balance of the spine and pelvis.

Conclusions

The scoliosis Cobb angle, thoracic kyphosis angle, and apical vertebral translation in the GMFCS level IV–V CP patients progressed with age. These findings can predict radiographic progression of scoliosis in CP patients.

     

Clinical evaluation of the stability of single-segment short pedicle screw fixation for the reconstruction of lumbar and sacral tuberculosis lesions

Introduction

The routine surgical approach to posterior reconstruction in spinal tuberculosis is short- or long-segment fixation and/or fusion. This method sacrifices movement at more than one vertebral level, limits normal movement of the spinal column, and leads to degeneration of the small joints of the adjacent levels. Surgical techniques that reduce the number of fixed vertebral levels and maximize the retention of movement of the spinal column are of current interest in the treatment of spinal tuberculosis.

Materials and methods

A total of 106 patients with lumbosacral tuberculosis were randomly divided into two groups: a single-segment fixation group and a short-segment fixation group. After posterior correction and internal fixation, all patients underwent anterior radical debridement and interbody fusion with bone grafting.

Results

The mean postoperative follow-up period was 58.09?±?17.01?months. The average bone graft healing time was 4.35?±?1.04?months in the single-segment group and 4.47?±?1.10?months in the short-segment group. In the single-segment group, correction of the Cobb angle was 14.47?±?3.76° and the loss rate was 7.22?%, and in the short-segment group, correction of the Cobb angle was 16.20?±?2.70° and the loss rate was 6.37?% (P?P?Conclusions Single-segment pedicle screw fixation and correction surgery can fix and fuse the diseased segment in lumbar and sacral tuberculosis, retain normal movement in the adjacent spinal column, and promote functional recovery of the spinal column postoperatively. It was be regarded as a cost-effective means of treatment with lumbar and sacral tuberculosis.     

Single balloon versus double balloon bipedicular kyphoplasty: a systematic review and meta-analysis

Introduction

Kyphoplasty has been widely used to treat vertebral compression fractures (VCFs). In standard procedure of kyphoplasty, two balloons were inserted into the vertebral body through bipedicular and inflated simultaneously, while using a single balloon two times is also a common method in clinic to lessen the financial burden of patients. However, the effect and safety of single balloon versus double balloon bipedicular kyphoplasty are still controversy.

Methods

In this systematic review and meta-analysis, eligible studies were identified through a comprehensive literature search of PubMed, Cochrane library EMBASE, Web of Science, Wanfang, CNKI, VIP and CBM until January 1, 2018. Results from individual studies were pooled using a random or fixed effects model.

Results

Seven articles were included in the systematic review and five studies were consisted in meta-analysis. We observed no significant difference between single balloon and double balloon bipedicular kyphoplasty in visual analog scale (VAS), angle (kyphotic angle and Cobb angle), consumption (operation time, cement volume and volume of bleeding), vertebral height (anterior height, medium height and posterior height) and complications (cement leakage and new VCFs), while the cost of single balloon bipedicular kyphoplasty is lower than that of double balloon bipedicular kyphoplasty. The results of our meta-analysis also demonstrated that single balloon can significantly improve the VAS, angle and vertebral height of patients suffering from VCFs.

Conclusion

This systematic review and meta-analysis collectively concludes that single balloon bipedicular kyphoplasty is as effective as double balloon bipedicular kyphoplasty in improving clinical symptoms, deformity and complications of VCFs but not so expensive.

Graphical Abstract

These slides can be retrieved under Electronic Supplementary Material.

Open image in new window

     

Hat die Nachtorthese in der Skoliosetherapie noch eine Berechtigung?

Background

The aim of our investigation was to evaluate the effectiveness of isolated night-time treatment in idiopathic scoliosis.

Methods

Twenty-two children (average age 11.9 years; range 5–12 years) underwent treatment with the“Dresdner night-time brace.” We indicated brace treatment in all children with a Cobb angle of 20–25° and also in those with an angle of 15–19° in cases of progression. Over a follow-up period of 25 months, clinical and radiological observations were made.

Results

A primary correction of 82.2% was obtained. The mean Cobb angle in an upright position without orthosis before treatment was 20.2°. At the end of treatment, this angle reached 15.8°. Operations were able to be avoided completely. In only three cases with radiographic progression (development of angles >25°), part-time bracing had to be stopped and changed to full-time bracing. We observed an overall success rate of 86.4% (patients with improved Cobb angles or halted progression).

Conclusion

We were able to show a positive effect of part-time bracing in selected patients with mild scoliosis and a higher risk of progression. The negative medical and psychosocial consequences of 23-h brace treatment can therefore be avoided in certain patients.     

Management of spinal deformity in cerebral palsy: conservative treatment

Introduction

The incidence of scoliosis in Cerebral Palsy (CP) is directly related to the Gross Motor Function Classification System (GMFCS) level. The natural history of untreated scoliosis in patients with CP is one of progression and factors implicated in deterioration include type of involvement (quadriplegia), poor functional status (nonambulatory, GMFCS levels IV and V), and curve location (thoracolumbar). The generally accepted incidence in the overall CP population is 20–25 %.

Materials and methods

We recently published our short term results for 31 children treated with a short lumbar brace. In cases of a "positive hands up test" we recommend a short lumbar brace, and in patients with scoliosis with a Cobb angle >20° a double shelled brace.

Results

In our study, there was a correction of 37 % for the lumbar Cobb angle and 39 % for the thoracic Cobb angle at a mean follow-up of 28 months.

Conclusion

The incidence of scoliosis in the overall CP population is 20–25 % and is directly related to the GMFCS level. Therefore, we recommend early treatment and prescribe a short lumbar brace in patients with dynamic instability of the trunk, and in scoliosis with a Cobb angle >20° a double shelled brace.     

Single-stage posterior vertebral column resection and internal fixation for old fracture–dislocations of thoracolumbar spine: a case series and systematic review

Purpose

To evaluate the efficacy of single-stage posterior vertebral column resection for old thoracolumbar fracture–dislocations with spinal cord injury.

Methods

From January 2007 to June 2013, twelve male patients (average age, 32.6 years; range 19–57 years) with old fracture–dislocations of the thoracolumbar spine and spinal cord injury underwent single-stage posterior vertebral column resection and internal fixation. All patients were assessed for relief of the pain and restoration of neurologic function. Postoperative Cobb angle was measured and bone graft fusion was evaluated by X-ray. A systematic review of 25 studies evaluating surgical management of thoracolumbar fractures with spinal cord injuries was also performed.

Results

From our case series, six of the nine patients with Frankel grade A had significant improvement in urination and defecation after surgery. The three patients with Frankel grades B and C had progression of 1–2 grades after surgery. Bony fusion was achieved and local back pain was relieved in all patients after surgery. From our systematic review of 25 studies, the majority of patients had improved back pain, the postoperative kyphotic angle was significantly reduced compared with pre-operative kyphotic angle.

Conclusion

Single-stage posterior vertebral column resection and internal fixation for old thoracolumbar fracture–dislocations is an ideal treatment allowing for thorough decompression, relief of pain, correction of deformities, and restoration of spinal stability.

Level of evidence

IV.

     

Behandlung der jugendlichen idiopathischen Skoliose mittels Korsett

Background

The purpose of this study was to analyze patients with adolescent idiopathic scoliosis (AIS) treated with bracing at The Royal Children’s Hospital in Melbourne Australia according to the Scoliosis Research Society (SRS) criteria and evaluate the effectiveness of this treatment method.

Patients and methods

During the 1 year survey 125 patients with AIS were treated with bracing and 52 (42?%) of those fulfilled the SRS criteria. Measurements were performed according to the follow-up visits at 6 and 12 months.

Results

The mean age of the patients was 13.1 years and the mean Cobb angle at the start of therapy was 31.8°. Thirtynine (76?%) patients were treated successfully and an improvement of the Cobb angle was achieved in 26 (51?%) patients. A further 6 patients (12?%) required surgery and 7 (14?%) showed a Cobb angle of more than 45° after reaching skeletal maturity.

Conclusion

The results show the effectiveness of bracing as a treatment method for patients with AIS. The SRS criteria provide good guidance to classify patients who are likely to benefit from this treatment. A better comparison of the outcome with other studies can be achieved by using these criteria.     

Reliability of assessing the coronal curvature of children with scoliosis by using ultrasound images

Purpose

To investigate the intra- and inter-observer reliability of the coronal curvature asymmetry of children with adolescent idiopathic scoliosis (AIS) using the center of lamina (COL) method on ultrasound (US) images.

Methods

A cadaver spinal column phantom which was manipulated to present 30 scoliotic curves of varying severity of scoliotic deformities was scanned using both the US and laser scanner (LS) systems. Three observers of varying experience and skill measured the coronal curvature using the Cobb method on the LS images and the COL method on the US images. All of the measurements were performed twice, with a 1-week interval to reduce memory bias. The intra-class correlation coefficient (ICC), the mean absolute differences (MAD), and the error index (EI) were calculated to determine the agreement on selecting the end vertebrae. In addition, five AIS subjects were scanned using the US system. One observer measured the coronal curvature on the US images twice, and the measurements were compared with the Cobb angle reported in the clinical records.

Results

In the phantom study, the COL method showed high intra- and inter-observer reliabilities, with all ICC values >0.88. The maximum MAD of the COL measurements between different sessions among all observers was <4.1°. The EI values of the US method had similar end-vertebra selections as the LS method. The results of the pilot study showed a high intra-reliability for the US measurements. The measured difference between the Cobb and COL methods was 0.7° ± 0.5°.

Conclusions

The COL method using US images appears to be a very reliable method for measuring the coronal curvature in AIS without the need to expose the patient to radiation.     

Die Compliance als Prognosefaktor bei der konservativen Behandlung idiopathischer Skoliosen

Background

The purpose of this study was to assess the compliance of brace treatment and the correlation with outcomes in patients with idiopathic scoliosis.

Methods

Ninety adolescent patients completed treatment with the Dresden scoliosis orthosis. After a mean follow-up time of 4.3 years, their level of compliance was retrospectively assessed and correlated with the radiographic results.

Results

The amount of primary correction was 36% in the lumbar spine and 25% in the thoracic spine. Of the patients, 59.4% were compliant (daily duration of brace treatment >20 h). The success rate in this group (improved or constant Cobb angles during therapy) was 89%. With good compliance and primary correction of more than 30%, the average Cobb angle at follow-up had improved by 8.3° in the thoracic spine and by 12.4° in the lumbar spine compared with the initial Cobb angle. Eleven of 39 patients in the noncompliant group but only four of 57 compliant patients underwent surgery.

Conclusion

Compliance with orthosis therapy and the amount of primary correction are together the most important factors for predicting the final outcome of brace treatment in idiopathic scoliosis. Influencing factors on compliance must be further analyzed.     

Transvertebral anterior key hole foraminotomy without fusion for the cervicothoracic junction

Background

Various surgical procedures have been used to repair disc herniations and osteophytes at the cervicothoracic junction. Among these procedures, transvertebral anterior foraminotomy without fusion is a relatively less invasive, safe and useful method, although the majority of spinal surgeons remain unfamiliar with this method. We describe the surgical procedure for a transvertebral anterior keyhole foraminotomy without fusion at the cervicothoracic junction, and we assess the middle-term clinical and radiological outcomes.

Methods

Of 118 patients undergoing this surgery in our institute between 2007 and 2010, five (4.2?%) had C8 radiculopathy causing C7/T1 disc herniations or osteophytes. We studied five patients who underwent trans-C7 vertebral keyhole foraminotomy without fusion. We retrospectively examined clinical data, pre- and postoperative neurological status.

Results

In all cases, surgical decompression was successfully achieved without difficulty when accessing the pathology. No complications related to the surgical procedure were reported. The follow-up period was 12–28 (mean 20) months. In all patients, the visual analogue scale (VAS) due to radicular pain immediately decreased after the operation and did not increase thereafter. The mean VAS decreased from 7.8 (4.5–9.6) to 1.0 (0–2.1). The Cobb angle at C2-T1 in a neutral position improved from ?12.6 (?2.8 to ?24.7) degrees to ?6.9 (4.2 to ?25.4). The postoperative C7/T1 disc height decreased from 5.4?to 4.9?mm, indicating minimal loss.

Conclusions

This procedure allows for direct access to the pathology and is less invasive. In this study, we clarified that this technique yields excellent radiological and clinical outcomes.     

A reliability and validity study for different coronal angles using ultrasound imaging in adolescent idiopathic scoliosis

Background Context

Radiation exposure remains a big concern in adolescent idiopathic scoliosis (AIS). Ultrasound imaging of the spine could significantly reduce or possibly even eliminate this radiation hazard. The spinous processes (SPs) and transverse processes (TPs) were used to measure the coronal deformity. Both landmarks provided reliable information on the severity of the curve as related to the traditional Cobb angle. However, it remained unclear which coronal ultrasound angle is the most appropriate method to measure the curve severity.

Relationship between the different torsion-related thoracic deformity parameters of adolescent idiopathic scoliosis

Introduction

Torsion has recently become essential in curve evaluation, not only to assess the degree of clinical deformity that can influence decision making, but also to predict curve progression. Since torsion cannot be currently measured using plain X-rays, our aim was to study the relationships between the different torsion-related parameters measured on 2D radiographs that can indirectly guide the clinician about the torsion of a given curve.

Methods

This is a cross-sectional study analyzing prospectively registered data of a consecutive cohort of 113 AIS patients with progressive main thoracic deformity. Demographic data, the Adams test and eight radiographic torsion-related coronal and sagittal deformity parameters [apical vertebral rotation (AVR)—Stokes method, Mehta angle (RVAD), main thoracic Cobb side-bending, T5–T12 kyphosis, T5–T8 kyphosis, T9–T12 kyphosis, kyphotic change and double rib contour sign (rib index)] were correlated between each other and with the main thoracic Cobb angle (MTCobb). Univariate linear regression and multiple linear stepwise regression analyses were performed as well.

Results

The radiographically measurable deformity parameters that best correlated with the MTCobb angle in idiopathic curves were: side-bending, RVAD, AVR and the Adams test. Sagittal variables were correlated the least with MTCobb. Coronal parameters as AVR, RVAD, side-bending and Adam test are highly intercorrelated. Sagittal variables are related between each other but are not directly related to coronal parameters.

Conclusions

There is a strong relationship between the Cobb angle, curve bending, the Mehta angle and the apical vertebral rotation. Together with the clinical Adams test, these are the most important radiographic torsion-related parameters to measure when assessing scoliosis in 2D.

Level of evidence

3.

     

The validity and reliability of “Spinal Mouse” assessment of spinal curvatures in the frontal plane in pediatric adolescent idiopathic thoraco-lumbar curves

Purpose

Radiological measurement has been accepted as the gold standard for evaluating scoliosis for many years. However, exposure of children to X-ray constitutes a major limitation of the radiological methods. Spinal Mouse (SM) is a safe, practical and easy to perform measurement of curvature in scoliosis, but its validity and reliability have not been investigated. The aim of this study was to investigate the validity and reliability of Cobb angle and SM measurements in children with adolescent idiopathic scoliosis (AIS).

Methods

Fifty-one patients with AIS who were followed up conservatively were included in the study. The mean age of the patients was 14.4 years (9–18 years). Frontal plane curvatures were evaluated with SM by 2 physiotherapists and the results were compared with radiological measurements. Radiological measurements were performed by 2 orthopedists.

Results

All the measurements were of the thoraco-lumbar curve and the mean value was 35.08° according to Cobb angle measurement. There was no difference between the interobserver measurements of SM (p = 0.256) while the Cobb degrees measured by the 2 orthopedists was different (p = 0.0001). We did not find a statistically significant difference between Cobb measurements and the SM measurements of observer 1 and 2 (p = 0.505). The interobserver and intraobserver agreement of the Cobb and SM measurements was excellent (ICC = 0.872–0.962). When the differences between the evaluations were compared, the interobserver SM differences were seen to be lower than the interobserver Cobb angle differences (p = 0.003). The agreement between the Cobb and SM measurements was higher for curves over 40°. We found a strong or very strong relationship between measurements made with the Cobb and SM methods (p < 0.0001).

Conclusions

We conclude that SM can be used for research and patient follow-up in the clinic as a safe, reliable, quick, and easy to use method with no side effects although it cannot be the only factor to consider when determining the treatment plan of AIS patients.

     

Efficacy of perioperative halo-gravity traction for treatment of severe scoliosis (≥100°)

Background

There have been no standardized surgical options for severe scoliotic curvatures ≥100°. Halo-gravity traction is a viable option for surgical treatment of severe scoliosis. The aim of this study was to evaluate the efficacy and safety of perioperative halo-gravity traction for scoliosis curves ≥100° with respect to radiographic outcomes and clinical complications.

Methods

A total of 21 scoliosis patients with ≥100° curves (average 118.7°; range 100°-158°) with a minimum 2-year follow-up (average 41.8 months; range 24.0-97.0 months) who underwent spinal instrumented fusion using perioperative halo-gravity traction were analyzed. Diagnoses were neuromuscular scoliosis (n = 10), idiopathic (n = 9), and congenital (n = 2). In all, 15 patients were treated by the anterior release procedure followed by final posterior fusion and 6 patients by posterior fusion alone. Six patients had only preoperative traction preceding posterior fusion alone, 6 patients only staged traction between anterior release and final posterior fusion, and 9 patients had both preoperative traction preceding anterior release and staged traction preceding final posterior fusion. The average overall traction period in all patients was 67 days (range 10–78 days).

Results

Radiographic outcomes demonstrated 51.3% correction of the major Cobb angle, 40 mm correction of apical vertebral translation, 76 mm increase of T1-S1 length, and 20.7% increase of space available for lungs at the ultimate follow-up (all comparisons P < 0.05). Preoperative traction demonstrated 27.5% correction of the major curve Cobb angle, 51.5 mm increase of T1-S1 length, 14.9% increase of space available for the lungs (all comparisons P < 0.05). Staged traction after anterior release demonstrated 37.2% correction of the major curve Cobb angle, 26.1 mm correction of apical vertebral translation, 56.5 mm increase of T1-S1 length, 14.2% increase of space available for the lungs (all comparisons P < 0.05). There were only two patients with a pin-site problem, and one required débridement. There were no neurological deficits or clinical complications.

Conclusions

Scoliosis patients with ≥100° curves can be managed successfully by corrective fusion surgery concomitant with perioperative halo-gravity traction without significant complications.     

Reliability of vertebral fracture assessment using multidetector CT lateral scout views: the Framingham Osteoporosis Study

Summary

Two radiologists evaluated images of the spine from computed tomography (CT) scans on two occasions to diagnose vertebral fracture in 100 individuals. Agreement was fair to good for mild fractures, and agreement was good to excellent for more severe fractures. CT scout views are useful to assess vertebral fracture.

Introduction

We investigated inter-reader agreement between two radiologists and intra-reader agreement between duplicate readings for each radiologist, in assessment of vertebral fracture using a semi-quantitative method from lateral scout views obtained by CT.

Methods

Participants included 50 women and 50 men (age 50-87?years, mean 70?years) in the Framingham Study. T4-L4 vertebrae were assessed independently by two radiologists on two occasions using a semi-quantitative scale as normal, mild, moderate, or severe fracture.

Results

Vertebra-specific prevalence of grade ??1 (mild) fracture ranged from 3% to 5%. We found fair (???=?56-59%) inter-reader agreement for grade ??1 vertebral fractures and good (???=?68-72%) inter-reader agreement for grade ??2 fractures. Intra-reader agreement for grade ??1 vertebral fracture was fair (???=?55%) for one reader and excellent for another reader (???=?77%), whereas intra-reader agreement for grade ??2 vertebral fracture was excellent for both readers (???=?76% and 98%). Thoracic vertebrae were more difficult to evaluate than the lumbar region, and agreement was lowest (inter-reader ???=?43%) for fracture at the upper (T4-T9) thoracic levels and highest (inter-reader ???=?76-78%) for the lumbar spine (L1-L4).

Conclusions

Based on a semi-quantitative method to classify vertebral fractures using CT scout views, agreement within and between readers was fair to good, with the greatest source of variation occurring for fractures of mild severity and for the upper thoracic region. Agreement was good to excellent for fractures of at least moderate severity. Lateral CT scout views can be useful in clinical research settings to assess vertebral fracture.     

Effect of vertebroplasty with bone filler device and comparison with balloon kyphoplasty

Purpose

To evaluate the effect of vertebroplasty with a bone filler device compared with balloon kyphoplasty.

Methods

A total of 222 patients underwent operations from January 2008 to October 2012. One-level fractures numbered 169 (86.7 %) cases and two-level fractures numbered 26 (13.3 %). A total of 221 vertebral levels were analyzed consequently. Vertebral height, compression ratio, and segmental Cobb’s angle were measured in preoperative and postoperative lateral X-rays.

Results

The compression ratio was the most influential parameter among three variables. Adjusted postoperative compression ratio was not significantly different between two operation groups. Bone cement leakage rates did not differ (p < 0.05). Bone cement distribution was spongy type in the majority of the vertebroplasty with bone filler device (94.5 %), but only in 42.0 % of the kyphoplasty. High bone densitometry readings and long period from diagnosis to operation were significant risk factors for bone cement leakage.

Conclusions

Vertebroplasty with a bone filler device could achieve equivalent compression reduction and bone cement leakage rate, as well as greater sponge-type bone cement distribution, which were advantages over balloon kyphoplasty.