J Korean Neurosurg Soc.  2013 Oct;54(4):275-279. 10.3340/jkns.2013.54.4.275.

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

• Lee HJ
• Hong JT
• Kim IS
• Kwon JY
• Lee SW

• KMID: 1499331
• DOI: http://doi.org/10.3340/jkns.2013.54.4.275

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.

Keyword

Cephalometric measurement; Basilar invagination; Odontoid process; Opisthion; C2 end plate; C1 arch

MeSH Terms

Humans
Odontoid Process
Pathology*
Spine

Figure

• 

  Fig. 1 Relevant landmarks and six-different measurements. 1 : Hard palate, 2 : Basion, 3 : Opisthion, 4 : The most caudal point on the midline occipital curve, 5 : Center of the second cervical pedicle, 6 : Midpoint of the caudal margin of the second cervical vertebra body, a : McRae line, b : Chamberlain line c, : McGregor line, d : Redlund-Johnell method, e : Ranawat method, f : Modified-Ranawat method, Asterion : odontoid tip.

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  Fig. 2 Measuring the six-differents methods in normal patient. A : McRae method, B : Chamberlain method, C : McGregor method, D : Redlund-Johnell method, E : Ranawat method, F : Modified-Ranawat method, Asterion : odontoid tip.

• 

  Fig. 3 Measuring the six-differents methods in basilar invagination patient. a : McRae method, b : Chamberlain method, c : McGregor method, d : Redlund-Johnell method, e : Ranawat method, f : Modified-Ranawat method, Asterion : odontoid tip.

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  Fig. 4 This graphs show the intraclass correlation coefficient score (original ICC score times one hundred) with inter-observer study. BI : basilar invagination.

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  Fig. 5 This graphs shows the intraclass correlation coefficient score (original ICC score times one hundred) with intra-observer study. BI : basilar invagination.

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