Home Reliability and validity of lumbar disc height quantification methods using magnetic resonance images
Article
Licensed
Unlicensed Requires Authentication

Reliability and validity of lumbar disc height quantification methods using magnetic resonance images

  • Vahid Abdollah , Eric C. Parent EMAIL logo and Michele C. Battié
Published/Copyright: February 13, 2018
Become an author with De Gruyter Brill
Submit Manuscript Author Information
Biomedical Engineering / Biomedizinische Technik
From the journal Biomedical Engineering / Biomedizinische Technik Volume 64 Issue 1

Abstract

Disc height has been a focus of research on disc degeneration and low back pain (LBP). However, choosing an appropriate method to quantify disc height remains controversial. The aim of the present study was to determine the reliability and construct validity of disc height quantification methods. Repeated semi-automatic measurements of L4–5 and L5–S1 discs were obtained from 43 T2-weighted mid-sagittal 3T magnetic resonance (MR) images of 22 subjects with LBP (43±13 years), blinded to prior measurements. Heights were calculated with area-based methods (using 60%, 80% and 100% of the disc width), and point-based methods (Hurxthal’s, Dabbs’ and combining the two). Intra-class correlation coefficients (ICC) and standard error of measurement (SEM) were estimated. Construct validity was assessed using correlation coefficients. Intra-rater ICC(3,1) of the area-based disc height measurements ranged from 0.84 to 0.99 with an inter-rater ICC(2,1) of 0.99. Measurements with point-based methods had lower intra- and inter-rater reliability ranging between 0.76 and 0.96 and between 0.84 and 0.98, respectively. Inter-rater SEM varied between 0.2 and 0.3 mm for area-based methods and between 0.3 and 0.7 mm for point-based methods. Excluding Dabbs’, high correlations (r>0.9) were observed between methods. Area-based height measurements using partial disc width demonstrated excellent reliability and construct validity and outperformed point-based methods.

Keywords: computer-aided measurement; intervertebral disc; intervertebral disc degeneration; intervertebral disc height; low back pain; magnetic resonance imaging; measurement reliability; reproducibility of results; validation studies
Corresponding author: Eric C. Parent, PT, MSc, PhD, Associate Professor, Department of Physical Therapy, Faculty of Rehabilitation Medicine, 2-50 Corbett Hall, University of Alberta, Edmonton, AB, T6G 2G4, Canada

Acknowledgements

Vahid Abdollah was a recipient of the University of Alberta Doctoral Recruitment Scholarship. All authors were recipients of a research grant provided by the Alberta Spine Foundation for the development of a programme for automatic quantitative measurements of the lumbar disc and vertebra signal intensity and morphology using T2-weighted MR images. Data collection was as part of a study entitled: creating a prediction rule to identify patients likely to respond to extension-oriented exercises and understanding the mechanisms in persons with low back pain: a study using clinical, MRI and neuromuscular assessment conducted by J. Fritz (PI), A. Cottrell, B. Hayes, E. Parent, K. Sanders funded by a collaborative grant from the Center for Contemporary Rehabilitation Research, Education and Practice (A collaborative between Rehabilitation Services, PM&R and College of Health) from December 2006 to 2007.

References

[1] Abdollah V, Parent EC, Battié M. Is the location of the signal intensity weighted centroid a reliable measurement of fluid displacement within the disc? Biomed Tech (Berl) 2018; 63: 453–460.10.1515/bmt-2016-0178Search in Google Scholar PubMed

[2] Boos N, Wallin A, Aebi M, Boesch C. A new magnetic resonance imaging analysis method for the measurement of disc height variations. Spine (Phila Pa 1976) 1996; 21: 563–570.10.1097/00007632-199603010-00006Search in Google Scholar PubMed

[3] Dabbs VM, Dabbs LG. Correlation between disc height narrowing and low-back pain. Spine (Phila Pa 1976) 1990; 15: 1366–1369.10.1097/00007632-199012000-00026Search in Google Scholar PubMed

[4] Edmondston SJ, Song S, Bricknell R V, et al. MRI evaluation of lumbar spine flexion and extension in asymptomatic individuals. Man Ther 2000; 5: 158–164.10.1054/math.2000.0356Search in Google Scholar PubMed

[5] Fardon DF, Williams AL, Dohring EJ, et al. Lumbar disc nomenclature: version 2.0: recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology. Spine J 2014; 14: 2525–2545.10.1016/j.spinee.2014.04.022Search in Google Scholar PubMed

[6] Frobin W, Brinckmann P, Biggemann M, et al. Precision measurement of disc height, vertebral height and sagittal plane displacement from lateral radiographic views of the lumbar spine. Clin Biomech (Bristol, Avon) 1997; 12: S1–S63.10.1016/S0268-0033(96)00067-8Search in Google Scholar

[7] Goh S, Tan C, Price RI, et al. Influence of age and gender on thoracic vertebral body shape and disc degeneration: an MR investigation of 169 cases. J Anat 2000; 197: 647–657.10.1046/j.1469-7580.2000.19740647.xSearch in Google Scholar PubMed PubMed Central

[8] Hancock MJ, Battie MC, Videman T, Gibbons L. The role of back injury or trauma in lumbar disc degeneration: an exposure-discordant twin study. Spine (Phila Pa 1976) 2010; 35: 1925–1929.10.1097/BRS.0b013e3181d60598Search in Google Scholar PubMed

[9] Hioki A, Miyamoto K, Shimizu K, Inoue N. Test-retest repeatability of lumbar sagittal alignment and disc height measurements with or without axial loading: a computed tomography study. J Spinal Disord Tech 2011; 24: 93–98.10.1097/BSD.0b013e3181dd611fSearch in Google Scholar PubMed

[10] Hurxthal LM. Measurement of anterior vertebral compressions and biconcave vertebrae. Am J Roentgenol Radium Ther Nucl Med 1968; 103: 635–644.10.2214/ajr.103.3.635Search in Google Scholar PubMed

[11] Kumar A, Beastall J, Hughes J, et al. Disc changes in the bridged and adjacent segments after Dynesys dynamic stabilization system after two years. Spine (Phila Pa 1976) 2008; 33: 2909–2914.10.1097/BRS.0b013e31818bdca7Search in Google Scholar PubMed

[12] Lohr KN, Aaronson NK, Alonso J, et al. Evaluating quality-of-life and health status instruments: development of scientific review criteria. Clin Ther 1996; 18: 979–992.10.1016/S0149-2918(96)80054-3Search in Google Scholar PubMed

[13] Lundon K, Bolton K. Structure and function of the lumbar intervertebral disk in health, aging, and pathologic conditions. J Orthop Sports Phys Ther 2001; 31: 291–303.10.2519/jospt.2001.31.6.291Search in Google Scholar PubMed

[14] Matteri RE, Pope MH, Frymoyer JW. A biplane radiographic method of determining vertebral rotation in postmortem specimens. Clin Orthop Relat Res 1976; 116: 95–98.10.1097/00003086-197605000-00015Search in Google Scholar

[15] Miyakoshi N, Abe E, Shimada Y, et al. Anterior decompression with single segmental spinal interbody fusion for lumbar burst fracture. Spine (Phila Pa 1976) 1999; 24: 67–73.10.1097/00007632-199901010-00016Search in Google Scholar PubMed

[16] Neubert A, Fripp J, Engstrom C, et al. Validity and reliability of computerized measurement of lumbar intervertebral disc height and volume from magnetic resonance images. Spine J 2014; 14: 2773–2781.10.1016/j.spinee.2014.05.023Search in Google Scholar PubMed

[17] Parent E, Fritz JHB. Development of a preliminary prediction rule to identify patients with low back pain responding to extension exercises. World Congr. Low Back Pain Pelvic Pain, Plenary Present. 2010.Search in Google Scholar

[18] Pearson AM, Spratt KF, Genuario J, et al. Precision of lumbar intervertebral measurements: does a computer-assisted technique improve reliability? Spine (Phila Pa 1976) 2011; 36: 572–580.10.1097/BRS.0b013e3181e11c13Search in Google Scholar PubMed

[19] Pfirrmann CW, Metzdorf A, Zanetti M, et al. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976) 2001; 26: 1873–1878.10.1097/00007632-200109010-00011Search in Google Scholar PubMed

[20] Pope MH, Hanley EN, Matteri RE, et al. Measurement of intervertebral disc space height. Spine (Phila Pa 1976) 1977; 2: 282–286.10.1097/00007632-197712000-00007Search in Google Scholar

[21] Portney LG, Watkins MP. Reliability of measurements. Foundations of clinical research application to practice. 5th ed. F.A. Davis Co., 2015: 77–96.Search in Google Scholar

[22] Shao Z, Rompe G, Schiltenwolf M. Radiographic changes in the lumbar intervertebral discs and lumbar vertebrae with age. Spine (Phila Pa 1976) 2002; 27: 263–268.10.1097/00007632-200202010-00013Search in Google Scholar PubMed

[23] Streiner DL, Norman GR. Health measurement scales: a practical guide to their development and use. Oxford, New York: Oxford University Press 2003.Search in Google Scholar

[24] Terwee CB, Bot SDM, de Boer MR, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol 2007; 60: 34–42.10.1016/j.jclinepi.2006.03.012Search in Google Scholar PubMed

[25] Tunset A, Kjaer P, Samir Chreiteh S, Secher Jensen T. A method for quantitative measurement of lumbar intervertebral disc structures: an intra- and inter-rater agreement and reliability study. Chiropr Man Therap 2013; 21: 26.10.1186/2045-709X-21-26Search in Google Scholar PubMed

[26] Twomey LT, Taylor JR. Age changes in lumbar vertebrae and intervertebral discs. Clin Orthop Relat Res 1987; 224: 97–104.10.1097/00003086-198711000-00013Search in Google Scholar

[27] Twomey L, Taylor J, Furniss B. Age changes in the bone density and structure of the lumbar vertebral column. J Anat 1983; 136: 15–25.Search in Google Scholar PubMed

[28] Videman T, Battié MC, Parent EC, et al. Progression and determinants of quantitative magnetic resonance imaging measures of lumbar disc degeneration: a five-year follow-up of adult male monozygotic twins. Spine (Phila Pa 1976) 2008; 33: 1484–1490.10.1097/BRS.0b013e3181753bb1Search in Google Scholar PubMed

[29] Walter SD, Eliasziw M, Donner A. Sample size and optimal designs for reliability studies. Stat Med 1998; 17: 101–110.10.1002/(SICI)1097-0258(19980115)17:1<101::AID-SIM727>3.0.CO;2-ESearch in Google Scholar PubMed

Received: 2017-06-02
Accepted: 2017-11-07
Published Online: 2018-02-13
Published in Print: 2019-02-25

©2019 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Review
  3. Wheeze sound analysis using computer-based techniques: a systematic review
  4. Research articles
  5. Effect of a combination of flip and zooming stimuli on the performance of a visual brain-computer interface for spelling
  6. A cost-sensitive Bayesian combiner for reducing false positives in mammographic mass detection
  7. Influence of acquisition frame-rate and video compression techniques on pulse-rate variability estimation from vPPG signal
  8. Design of a secure remote management module for a software-operated medical device
  9. Long-term recording of electromyographic activity from multiple muscles to monitor physical activity of participants with or without a neurological disorder
  10. Biomechanical investigation of different surgical strategies for the treatment of rib fractures using a three-dimensional human respiratory model
  11. Numerical investigation of complete mandibular dentures stabilized by conventional or mini implants in patient individual models
  12. Reliability and validity of lumbar disc height quantification methods using magnetic resonance images
  13. Designs and performance of three new microprocessor-controlled knee joints
https://doi.org/10.1515/bmt-2017-0086
Keywords for this article
computer-aided measurement; intervertebral disc; intervertebral disc degeneration; intervertebral disc height; low back pain; magnetic resonance imaging; measurement reliability; reproducibility of results; validation studies

Articles in the same Issue

  1. Frontmatter
  2. Review
  3. Wheeze sound analysis using computer-based techniques: a systematic review
  4. Research articles
  5. Effect of a combination of flip and zooming stimuli on the performance of a visual brain-computer interface for spelling
  6. A cost-sensitive Bayesian combiner for reducing false positives in mammographic mass detection
  7. Influence of acquisition frame-rate and video compression techniques on pulse-rate variability estimation from vPPG signal
  8. Design of a secure remote management module for a software-operated medical device
  9. Long-term recording of electromyographic activity from multiple muscles to monitor physical activity of participants with or without a neurological disorder
  10. Biomechanical investigation of different surgical strategies for the treatment of rib fractures using a three-dimensional human respiratory model
  11. Numerical investigation of complete mandibular dentures stabilized by conventional or mini implants in patient individual models
  12. Reliability and validity of lumbar disc height quantification methods using magnetic resonance images
  13. Designs and performance of three new microprocessor-controlled knee joints
Sign up now to receive a 20% welcome discount
Institutional Access
How does access work?
Have an idea on how to improve our website?
Please write us.
© 2025 De Gruyter Brill
Downloaded on 22.10.2025 from https://www.degruyterbrill.com/document/doi/10.1515/bmt-2017-0086/html?lang=en
Scroll to top button