Palpatory accuracy of lumbar spinous processes using multiple bony landmarks.
ABSTRACT Accurate localization of vertebral segments is crucial for many treatment procedures. The objective of this study was to determine accuracy of identification of lumbar spinous process levels by palpation.
Three examiners independently identified the spinous processes of L1-L4 on 60 prone volunteers using multiple bony landmarks including the sacral base, L5, Tuffier's line, T12, and the 12th ribs. The spinous processes were marked with radiopaque skin markers. Location of marker placement and presence of anatomical anomalies were determined by posteroanterior lumbar radiographs. Accuracy of marker placement and interobserver reliability were assessed using weighted κ values. Generalized linear mixed models and Cochran-Mantel-Haenszel tests assessed the relationship of accuracy to training level, presence of anatomical anomalies, and participant characteristics.
Examiners identified a spinous process in 91% of vertebral assessments. Correct identification of vertebral level occurred 69% of the time (κ = 0.81; 95% confidence interval, 0.79-0.83). Faculty examiners were significantly more accurate in identifying the correct vertebral level than the resident examiner (67%-78% vs 51%, P ≤ .03). The presence of 12th rib anomalies decreased accuracy for all examiners (P ≤ .05), reducing accuracy from 74% to 55%. Accuracy was higher in male participants than in female participants (P = .01). Obesity significantly decreased accuracy (P = .0003) at L3 (50% vs 73%) and L4 (44% vs 72%).
Identification of lumbar spinous processes using multiple landmarks was more accurate than previously reported values. However, accuracy was dependent on examiner experience, presence of anatomical anomalies, and participant characteristics.
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ABSTRACT: To investigate inter- and intra-observer agreement in the assessment of lumbar vertebral rotational (VR) asymmetry by a motion palpation test. For this prospective and descriptive test-retest study, 51 asymptomatic participants (40 women, 11 men; mean age 23.3 [SD 5.6] years) were recruited from the community. Each participant was assessed in two sessions by the same three observers, who assessed VR by means of a palpatory test for movement asymmetry. This test is performed by applying posteroanterior pressure in an alternating manner to the left and right transverse processes of a vertebra to determine motion asymmetry in the transverse plane and thus the vertebral position. Observers classified the vertebral position as neutral, rotation to the right, and rotation to the left; they were blinded to which participant was being assessed and to any previous results. Intra- and inter-observer agreement was verified by the kappa coefficient (κ) and the weighted kappa coefficient (κ w ). Values of κ and κ w varied from 0.07 (95% CI, -0.10 to 0.245) to 0.37 (95% CI, 0.11-0.63) for intra-observer agreement and from 0.12 (95% CI, -0.06 to 0.29) to 0.30 (95% CI, 0.08-0.52) for inter-observer agreement. The motion palpation test used to assess VR asymmetry has low agreement levels; therefore, its clinical significance for measuring vertebral position is questionable.Physiotherapy Canada 04/2015; 67(2):169-173. DOI:10.3138/ptc.2014-16 · 0.61 Impact Factor
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ABSTRACT: Practitioners in several of the health care professions use anatomical landmarks to identify spinal levels, both in order to enhance diagnostic accuracy and to specifically target the site of intervention. Authoritative sources usually state the upright inferior scapular angle (IAS) aligns with the spinous process (SP) of T7, but some specify the T7-8 interspace or the T8 SP. The primary goals of this study were to systematically review the relevant literature; and conduct a meta-analysis of the pooled data from retrieved studies to increase their statistical power. Electronic searching retrieved primary studies relating the IAS to a spinal level, as determined by an imaging reference standard, using combinations of these search terms: scapula, location, landmark, spinous process, thoracic vertebrae, vertebral level, palpation, and spine. Only primary studies were included; review articles and reliability studies related to scapular position but lacking spinal correlations were excluded. Eight-hundred and eighty (880) articles of interest were identified, 43 abstracts were read, 22 full text articles were inspected, and 5 survived the final cut. Each article (with one exception) was rated for quality using the QUADAS instrument. Pooling data from 5 studies resulted in normal distribution in which the upright IAS on average aligns closely with the T8 SP, range T4-T11. Since on average the IAS most closely identifies the T8 SP in the upright position, it is very likely that health professionals, both manual therapists and others, who have been diagnosing and treating patients based on the IAS = T7 SP rule (the conventional wisdom), have not been as segmentally accurate as they may have supposed. They either addressed non-intended levels, or made numeration errors in their charting. There is evidence that using the IAS is less preferred than using the vertebra prominens, and may be less preferred than using the iliac crest for identifying spinal levels Manual therapists, acupuncturists, anesthesiologists, nurses, and surgeons should reconsider their procedures for identifying spinal sites in light of this modified information. Inaccurate landmark benchmark rules will add to patient variation and examiner errors in producing spine care targeting errors, and confound research on the importance of specificity in treating spinal levels. Electronic supplementary material The online version of this article (doi:10.1186/s12998-014-0050-7) contains supplementary material, which is available to authorized users.02/2015; 23(7). DOI:10.1186/s12998-014-0050-7
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ABSTRACT: Background The main objective of the present method was to automatically obtain a spatial curve of the thoracic and lumbar spine based on a 3D shape measurement of a human torso with developed scoliosis. Manual determination of the spine curve, which was based on palpation of the thoracic and lumbar spinous processes, was found to be an appropriate way to validate the method. Therefore a new, noninvasive, optical 3D method for human torso evaluation in medical practice is introduced.Methods Twenty-four patients with confirmed clinical diagnosis of scoliosis were scanned using a specially developed 3D laser profilometer. The measuring principle of the system is based on laser triangulation with one-laser-plane illumination. The measurement took approximately 10 seconds at 700 mm of the longitudinal translation along the back. The single point measurement accuracy was 0.1 mm. Computer analysis of the measured surface returned two 3D curves. The first curve was determined by manual marking (manual curve), and the second was determined by detecting surface curvature extremes (automatic curve). The manual and automatic curve comparison was given as the root mean square deviation (RMSD) for each patient. The intra-operator study involved assessing 20 successive measurements of the same person, and the inter-operator study involved assessing measurements from 8 operators.ResultsThe results obtained for the 24 patients showed that the typical RMSD between the manual and automatic curve was 5.0 mm in the frontal plane and 1.0 mm in the sagittal plane, which is a good result compared with palpatory accuracy (9.8 mm). The intra-operator repeatability of the presented method in the frontal and sagittal planes was 0.45 mm and 0.06 mm, respectively. The inter-operator repeatability assessment shows that that the presented method is invariant to the operator of the computer program with the presented method.Conclusions The main novelty of the presented paper is the development of a new, non-contact method that provides a quick, precise and non-invasive way to determine the spatial spine curve for patients with developed scoliosis and the validation of the presented method using the palpation of the spinous processes, where no harmful ionizing radiation is present.BMC Medical Imaging 02/2015; 15(1):2. DOI:10.1186/s12880-015-0044-5 · 0.98 Impact Factor