Determination of thoracic and lumbar spinal processes by their percentage position between C7 and the PSIS level

BackgroundAccurate measurements of spinal movement require reliable determination of anatomical landmarks. Current methods of identifying these are not sufficiently reliable or valid for this purpose. A reliable and convenient method of placing markers on selected vertebra is needed to compare measurements between different testers, subjects and sessions.FindingsTwo testers palpated T4, T7, T10, L1 and L4 spinal processes according to established criteria. They measured the position of spinal processes between C7 and the Posterior Superior Iliac Spine (PSIS) at the Pelvis independently using a flexible ruler placed on the spine. Subjects with a wide range of body heights but without visible spinal deformities were recruited for measurements. Reliability was calculated using absolute and relative values. Mean percentage position and 95% Confidence Intervals were calculated using the mean of both testers’ measurement for all subjects.Twenty-two subjects participated. The mean distance between C7 and the PSIS level was 50.9 cm (SD: 3.5 cm). Relative reliability for all spinal processes was almost perfect (ICC: > 0.9). Absolute reliability values showed high agreement between testers. Percentage position of T4 was found to be situated 21% along the distance between C7 and the PSIS level, T7 at 39%, T10 at 54.1%, L1 at 70.9% and L4 at 86.1% accordingly. 95% Confidence intervals around mean percentage positions had a maximum at L1 with 2.8% range from upper to lower limit.ConclusionsThe distance of three thoracic and two lumbar spinal processes can be reliably and accurately measured by independent testers, using a flexible ruler. Percentage positions between C7 and PSIS level correspond to spinal processes for subjects without visible deformities in the sagittal and frontal plane.

[1]  D. Altman,et al.  STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENT , 1986, The Lancet.

[2]  M M Panjabi,et al.  Human Lumbar Vertebrae: Quantitative Three-Dimensional Anatomy , 1992, Spine.

[3]  Elizabeth A. Tully,et al.  Skin movement errors in measurement of sagittal lumbar and hip angles in young and elderly subjects. , 2008, Gait & posture.

[4]  P. Pynsent,et al.  Which spinal levels are identified by palpation of the iliac crests and the posterior superior iliac spines? , 2007, Journal of anatomy.

[5]  M M Panjabi,et al.  Cervical Human Vertebrae Quantitative Three‐Dimensional Anatomy of the Middle and Lower Regions , 1991, Spine.

[6]  J. R. Landis,et al.  The measurement of observer agreement for categorical data. , 1977, Biometrics.

[7]  L. Murphy,et al.  Reliability of Spinal Palpation for Diagnosis of Back and Neck Pain: A Systematic Review of the Literature , 2004, Spine.

[8]  S. Barnard,et al.  Simple anatomical information improves the accuracy of locating specific spinous processes during manual examination of the low back. , 2009, Manual therapy.

[9]  Jane C. Johnson,et al.  Palpatory accuracy of lumbar spinous processes using multiple bony landmarks. , 2011, Journal of manipulative and physiological therapeutics.

[10]  C Frigo,et al.  The upper body segmental movements during walking by young females. , 2003, Clinical biomechanics.

[12]  A. Kvåle,et al.  Reliability and validity of a palpation technique for identifying the spinous processes of C7 and L5. , 2009, Manual therapy.

[13]  Young Jin Ko,et al.  Interexaminer reliability and accuracy of posterior superior iliac spine and iliac crest palpation for spinal level estimations. , 2007, Journal of manipulative and physiological therapeutics.

[14]  Robert Cooperstein,et al.  Determining spinal level using the inferior angle of the scapula as a reference landmark: a retrospective analysis of 50 radiographs. , 2008, The Journal of the Canadian Chiropractic Association.

[15]  W. Vach,et al.  Manual examination of the spine: a systematic critical literature review of reproducibility. , 2006, Journal of manipulative and physiological therapeutics.

[16]  J. Fleiss,et al.  Intraclass correlations: uses in assessing rater reliability. , 1979, Psychological bulletin.

[17]  J. Richards,et al.  The measurement of human motion: A comparison of commercially available systems , 1999 .

[18]  C. O’Haire,et al.  Inter-examiner and intra-examiner agreement for assessing sacroiliac anatomical landmarks using palpation and observation: pilot study. , 2000, Manual therapy.

[19]  Stephan Milosavljevic,et al.  The Spineangel: Examining the validity and reliability of a novel clinical device for monitoring trunk motion. , 2010, Manual therapy.

[20]  K. Dunleavy,et al.  Reliability and minimal detectable change of spinal length and width measurements using the Flexicurve for usual standing posture in healthy young adults. , 2010, Journal of back and musculoskeletal rehabilitation.

[21]  H. Hirschfeld,et al.  Joint coordination during whole-body lifting in women with low back pain after pregnancy. , 2002, Archives of physical medicine and rehabilitation.

[22]  F. Cheriet,et al.  Clinical methods for quantifying body segment posture: a literature review , 2011, Disability and rehabilitation.

[23]  Derek Field,et al.  Anatomy, Palpation and Surface Markings , 1994 .

[24]  Seokyung Shin,et al.  Identification of the Correct Cervical Level by Palpation of Spinous Processes , 2011, Anesthesia and analgesia.

[25]  A. Beckett,et al.  AKUFO AND IBARAPA. , 1965, Lancet.

[26]  M M Panjabi,et al.  Thoracic Human Vertebrae Quantitative Three‐Dimensional Anatomy , 1991, Spine.

[27]  D. Teoh,et al.  Surface Anatomy as a Guide to Vertebral Level for Thoracic Epidural Placement , 2009, Anesthesia and analgesia.

[28]  Orit Shechtman,et al.  Foundations of Clinical Research: Applications to Practice, 2nd Edition, Leslie Gross Portney, Mary P. Watkins. Prentice Hall, Upper Saddle River, NJ (2000), 752 pages. $60 , 2001 .

[29]  Michael T. Haneline,et al.  A review of intraexaminer and interexaminer reliability of static spinal palpation: a literature synthesis. , 2009, Journal of manipulative and physiological therapeutics.

[30]  Nicola R Heneghan,et al.  Manual palpation of lumbo-pelvic landmarks: a validity study. , 2012, Manual therapy.

[31]  Stephan Milosavljevic,et al.  Palpation identification of spinous processes in the lumbar spine. , 2007, Manual therapy.