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MSc Research Project
- 1. Is the measurement of the depth and translation of the lumbar vertebral bodies using ultrasound imaging reliable? John Doyle MSc Advanced Physiotherapy Candidate September 2012
- 2. Objectives •Intra and inter-rater reliability • Measure of depth from skin to vertebral bodies •Inter-rater reliability of measure of sagittal translation of vertebral bodies
- 3. Background •Diagnosis of Spondylolisthesis •MRI, CT, Functional radiography (Leone 2009, Watters 2009) •PPIVMS/ PAIVMS (Abbot 2005) •Ultrasound clinical uses •Abdominal and trunk muscle function (Hebert 2009) •Sono-anatomical recognition for interventional procedures (Grau 2001)
- 4. Background • Correlation between ultrasound and X-Ray in diagnosis of spondylolisthesis Tallroth (1988) • No reliability studies of ultrasound measurement of vertebral bodies
- 5. Skin Insert slide title here Spinous Multifidus process Ligamentum Flavum Posterior edge of vertebral body
- 6. Methods •Depth of vertebral bodies of L5,4 & 3 measured in Flexion and Extension •Position standardised between tests •Intra and inter-rater reliability
- 7. Methods •Inter-rater reliability of the measurement of sagittal translation: • Depth of vertebral body in flexion- extension
- 8. Statistical Analysis •Intra-class correlation coefficient (ICC) •Bland and Altman plots (Rankin and Stokes 1998)
- 14. Discussion •Potential use for recognition of abnormal sagittal translation at L5 •Abnormal translation associated with persistent and severe back pain (Kanemura 2009) •Standard error of measurement 0.27cm
- 15. Discussion • sample • wide confidence intervals • not compared to gold standard • lack of fixed reference point • transducer head pressure
- 16. Conclusion • ultrasound measurement of the depth of vertebral body appears reliable • Increased error associated with sagittal translation measure • Identification of vertebral body not compared to gold standard
Editor's Notes
- The aim of this study was to investigate the intra and inter-rater reliability of the measurement of the depth of the 3rd, 4th and 5th vertebral bodies of the lumbar spine and the saggital translation of the lumbar vertebral bodies that occurs during flexion and extension using ultrasound imagaing.
- This study was born out of the need for a simple, reliable and cost effective method of diagnosing spondylolisthesis. there are several methods currently used including MRI, CT scan and the method currently recommended by the north american spine society: flexion/ extension radiography. Ultrasound has been used with good reliability to quantatively assess abdominal and trunk muscle function. There is also growing use of ultrasound in determining sono-anatomical landmarks for improving the accuracy of procedures such as epidural anaesthesia and facet joint blocks
- There has been a study of the use of ultrasound to diagnose spondylolisthesis which showed there was a strong correlation between radiograph and ultrasound diagnosis. There have been no studies investigating the reliability of recognising and measuring the vertebral boodies of the lumbar spine and quantifying saggital translation using ultrasound.
- A combination of intraclass correlation coefficient and bland and altman plots were used to assess reliability in this study. The icc gives a measure of the absolute agreement between raters, whilst the bland and altman plots provide insight into the range and the distribution of any error.Standard error of measurement of saggital translation was calculated to assess the precision of the measurement
- Excellent inter rater reliability demonstrated for the measure of the depth of the 4th and 5th vertebral bodies when the participant was in a flexed and an extended position
- Example of a blnad and altman plot of agreement...no systematic error or homoscedasticity/heteroscedasticity.
- The ICC shows that there is moderate agreement for the measure of saggital translation that occurs at the 5th vertebral body between a flexed and extended lumbar spine position