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Chiropractic Research Review

Evaluating Four Methods of Lumbar Lordosis Analysis

There is much debate over the whether lumbar lordosis is a precursor to back pain; however, the first step in looking at this issue is to be able to accurately measure lordosis. This study attempts to determine the reliability of four methods of measuring lumbar lordosis on radiographs.

Cobbs method is widely used to analyze lumbar curvature on lateral radiographic images, but TRALL (tangential radiologic assessment of lumbar lordosis), centroid, and Harrison posterior tangent methods are not as commonly performed.

Researchers used a delayed, repeated-measures method to evaluate the accuracy of three examiners, who twice digitized 30 lumbar lateral radiographs. Segmental centroid, global centroid, Cobb angles, and posterior tangent intersections angles were created. The results showed that "the interobserver and intraobserver reliabilities of measuring all segmental and global angles were in the high range ... the mean absolute differences of observers' measurements were small (0.6° - 2.0°)."

Conclusion: The authors state that all four of the radiographic methods are reliable and produce low average absolute differences between observer measurements. However, the clinical utility of the information is important. Depending on the type of information the examiner requires, the appropriate measurement system should be selected.

Harrison DE, Harrison DD, Cailliet R, et al. Radiographic analysis of lumbar lordosis: Centroid, Cobb, TRALL, and Harrison posterior tangent methods. Spine, June 1, 2001:26(11), pp. e235-e242.

Chiropractic Research Review

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