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Chiropractic Research Review

Measuring Lumbar Lordosis: A Replacement for the Cobb Technique?

Clinical evidence suggests that maintenance of the normal lumbar lordotic curve can be a significant factor in the prevention of spinal disorders. Several different methods are commonly utilized to measure lumbar lordosis, including the Cobb technique, which measures vertebral endplates and is frequently used for measuring lordosis of the lumbar spine.

However, the vertebral surface angle can be difficult to measure because of variations in the vertebral endplate architecture, a complication that the author of this study notes can "reduce the reliability of the Cobb technique." Instead, he suggests "vertebral centroid measurement" of lumbar lordosis (CLL), in which contours of the L1, L2 and L5 vertebral bodies serve as the basis for determining the lordotic angle. He compared this procedure with the Cobb technique in a study involving 16 healthy participants.

Lateral radiographs were taken from the upright position to a trunk flexion of 90° in 30° increments; the lumbar lordotic curve was measured by three observers individually by using two applications of the traditional Cobb technique and using the CLL technique. The intraobserver measures of reliability were good for both methods, but better for the CLL method. Results showed that the CLL technique was more reliable in determining the lumbar lordotic curve than the Cobb method, and these results were maintained regardless of the vertebral endplate selected. This measurement method also revealed the smallest mean absolute differences between any two observers measurements.

The author recommends that vertebral centroid measurement be regarded as an alternative technique for clinical diagnosis of the lordotic curve, noting that it is more reliable than the Cobb method. However, he warns that the homogenous nature of the study population should be considered before this method is widely applied.

Take Note: As the author mentions, only healthy Chinese males 24-41 years of age were included as subjects in this study. More research into other areas of the spine and in larger and more varied study samples is necessary before applying this method to the general patient population.

Chen YL. Vertebral centroid measurement of lumbar lordosis compared with the Cobb technique. Spine, Sept. 1, 1999:24(17), pp1786-1790.

Chiropractic Research Review

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