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Analysis of Measurement Accuracy for Craniovertebral Junction Pathology : Most Reliable Method for Cephalometric Analysis

  • Lee, Ho Jin (Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea) ;
  • Hong, Jae Taek (Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea) ;
  • Kim, Il Sup (Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea) ;
  • Kwon, Jae Yeol (Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea) ;
  • Lee, Sang Won (Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea)
  • Received : 2013.01.21
  • Accepted : 2013.09.30
  • Published : 2013.10.28

Abstract

Objective : This study was designed to determine the most reliable cephalometric measurement technique in the normal population and patients with basilar invagination (BI). Methods : Twenty-two lateral radiographs of BI patients and 25 lateral cervical radiographs of the age, sex-matched normal population were selected and measured on two separate occasions by three spine surgeons using six different measurements. Statistical analysis including intraclass correlation coefficient (ICC) was carried out using the SPSS software (V. 12.0). Results : Redlund-Johnell and Modified (M)-Ranawat had a highest ICC score in both the normal and BI groups in the inter-observer study. The M-Ranawat method (0.83) had a highest ICC score in the normal group, and the Redlund-Johenll method (0.80) had a highest ICC score in the BI group in the intra-observer test. The McGregor line had a lowest ICC score and a poor ICC grade in both groups in the intra-observer study. Generally, the measurement method using the odontoid process did not produce consistent results due to inter and intra-observer differences in determining the position of the odontoid tip. Opisthion and caudal point of the occipital midline curve are somewhat ambiguous landmarks, which induce variable ICC scores. Conclusion : On the contrary to other studies, Ranawat method had a lower ICC score in the inter-observer study. C2 end-plate and C1 arch can be the most reliable anatomical landmarks.

Keywords

References

  1. Chamberlain WE : Basilar Impression (Platybasia) : A Bizarre Developmental Anomaly of the Occipital Bone and Upper Cervical Spine with Striking and Misleading Neurologic Manifestations. Yale J Biol Med 11 : 487-496, 1939
  2. Clark CR, Goetz DD, Menezes AH : Arthrodesis of the cervical spine in rheumatoid arthritis. J Bone Joint Surg Am 71 : 381-392, 1989 https://doi.org/10.2106/00004623-198971030-00012
  3. Dziurzynski K, Anderson PA, Bean DB, Choi J, Leverson GE, Marin RL, et al. : A blinded assessment of radiographic criteria for atlanto-occipital dislocation. Spine 30 : 1427-1432, 2005 https://doi.org/10.1097/01.brs.0000166524.88394.b3
  4. Kauppi M, Sakaguchi M, Konttinen YT, Hamalainen M : A new method of screening for vertical atlantoaxial dislocation. J Rheumatol 17 : 167-172, 1990
  5. Kawaida H, Sakou T, Morizono Y : Vertical settling in rheumatoid arthritis. Diagnostic value of the Ranawat and Redlund-Johnell methods. Clinical Clin Orthop Relat Res 239 : 128-135, 1989
  6. Kwong Y, Rao N, Latief K : Craniometric measurements in the assessment of craniovertebral settling : are they still relevant in the age of cross-sectional imaging? AJR Am J Roentgenol 196 : W421-W425, 2011 https://doi.org/10.2214/AJR.10.5339
  7. Mc GM : The significance of certain measurements of the skull in the diagnosis of basilar impression. Br J Radiol 21 : 171-181, 1948 https://doi.org/10.1259/0007-1285-21-244-171
  8. McRae DL, Barnum AS : Occipitalization of the atlas. Am J Roentgenol Radium Ther Nucl Med 70 : 23-46, 1953
  9. Mikulowski P, Wollheim FA, Rotmil P, Olsen I : Sudden death in rheumatoid arthritis with atlanto-axial dislocation. Acta Med Scand 198 : 445-451, 1975
  10. Nagayoshi R, Ijiri K, Takenouchi T, Taketomi E, Sakakima H, Komiya S : Evaluation of occipitocervical subluxation in rheumatoid arthritis patients, using coronal-view reconstructive computed tomography. Spine 34 : E879-E881, 2009 https://doi.org/10.1097/BRS.0b013e3181b26cc9
  11. Parish DC, Clark JA, Liebowitz SM, Hicks WC : Sudden death in rheumatoid arthritis from vertical subluxation of the odontoid process. J Natl Med Assoc 82 : 297-299, 302-304, 1990
  12. Ranawat CS, O'Leary P, Pellicci P, Tsairis P, Marchisello P, Dorr L : Cervical spine fusion in rheumatoid arthritis. J Bone Joint Surg Am 61 : 1003-1010, 1979 https://doi.org/10.2106/00004623-197961070-00006
  13. Redlund-Johnell I, Pettersson H : Radiographic measurements of the cranio-vertebral region. Designed for evaluation of abnormalities in rheumatoid arthritis. Acta Radiol Diagn (Stockh) 25 : 23-28, 1984 https://doi.org/10.1177/028418518402500105
  14. Riew KD, Hilibrand AS, Palumbo MA, Sethi N, Bohlman HH : Diagnosing basilar invagination in the rheumatoid patient. The reliability of radiographic criteria. J Bone Joint Surg Am 83 : 194-200, 2001 https://doi.org/10.2106/00004623-200102000-00006

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