The accuracy and validity of 'routine' X-rays in estimating lumbar disc arthroplasty placement
| Autor: | Matthew Trewhella, Y. Raja Rampersaud, Laurence A. G. Marshman, Tai Friesem, Jean-Charles Le Huec, Manoj Krishna |
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| Rok vydání: | 2007 |
| Předmět: |
Adult
Male Adolescent Radiography medicine.medical_treatment Lumbar disc Lumbar Computer software Preoperative Care Back pain medicine Humans Orthopedics and Sports Medicine Single-Blind Method Prospective Studies Arthroplasty Replacement Intervertebral Disc Lumbar Vertebrae business.industry Diagnostic Tests Routine Total Disc Arthroplasty Middle Aged Arthroplasty Standard error Female Spinal Diseases Neurology (clinical) medicine.symptom business Nuclear medicine Tomography Spiral Computed |
| Zdroj: | Spine. 32(23) |
| ISSN: | 1528-1159 |
| Popis: | STUDY DESIGN Original study. OBJECTIVE To compare the accuracy of radiograph (XR) estimates of lumbar total disc arthroplasty placement with high-resolution computed tomography (CT). SUMMARY OF BACKGROUND DATA Most lumbar disc arthroplasties are inserted and subsequently analyzed using anteroposterior and lateral XR: XR estimates are often correlated with clinical outcomes. No study has hitherto assessed the relative accuracy of XR estimates with CT. METHODS Patients (N = 36) had recently undergone uncomplicated lumbar total disc arthroplasty for unresponsive discogenic back pain. Interpedicular midline malplacement and vertebral body penetration (VBP) were estimated after surgery, by "blinded" independent review, using computer software on both nonrotated XR and high-resolution CT at the same clinic attendance. RESULTS Results were obtained in N = 36 patients. No significant differences were found between XR and CT in the mean +/- standard error estimation of either midline malplacement (1.7 +/- 0.2 mm vs. 1.8 +/- 0.2 mm, P = 0.86) or VBP (1.5 +/- 0.3 mm vs. 1.6 +/- 0.3 mm, P = 0.79). However, the correlation between XR and CT for midline malplacement appeared strong (r = 0.72, P 0.10). The standard deviation of XR-CT differences for VBP (2.2 mm) was almost twice that for midline malplacement (1.2 mm). XR-CT differences exceeded the 95% limit of agreement in 6% of midline placement estimates, and in 8% for VBP. CONCLUSION Nonrotated XR permitted an accurate and valid estimate of midline malplacement relative to CT in most cases. However, the correlation was biased toward XR underestimation of CT-derived malplacement, and highly significant XR-CT differences occurred in 6% of estimates: early postoperative CT is therefore recommended to enhance the estimation of midline placement. XR-CT agreement for VBP was poor: CT is therefore indicated in all cases for this parameter. This is the first study to compare the accuracy of XR in estimating lumbar total disc arthroplasty placement with CT. |
| Databáze: | OpenAIRE |
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