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Diagnostic Performance
As discussed in Current Standard of Care, a well-known problem with end-range x-rays is the high level of variability in the resulting intervertebral (IVA) measurement. Generally, high measurement variability in a quantitative diagnostic test leads to poor diagnostic performance. Researchers have shown this to be the case for end-range x-rays, where high measurement variability makes meaningful definitions of normative motion impossible.1-4 This means that outside of gross hypermobility, end-range x-rays cannot be used to detect abnormal motion. Furthermore, end-rage x-rays cannot correlate motion to pain; thus they don’t fulfill the basic diagnostic purpose for which they are intended.
Fusion outcomes gap
Of the 400,000+ lumbar and cervical fusions per year in the U.S., over 90% are technically successful, but 60-70% are effective at relieving pain.5-7 This gap in fusion outcomes highlights a major opportunity for improvement in spine diagnostic performance.
- Dvorak J, Panjabi MM, Noventoy JE, Chang DG, Grob D. 1. Clinical Validation of Functional Flexion-Extension Roentgenograms of the Lumbar Spine. Spine 1991; 16(8):943-950
- Boden SD, et. al. Lumbosacral segmental motion in normal individuals. Have we been measuring instability properly? Spine. 1990;15(6):571-576
- Penning L, et. al. Inability to prove instability. A critical appraisal of clinical-radiological flexion-extension studies in lumbar disc degeneration. Diagn Imaging Clin Med. 1984;53(4):186-192
- Shaffer WO, Spratt KF, Weinstein J, Lehmann TR, Goel V. 1990 Volvo Award in clinical sciences. The consistency and accuracy of roentgenograms for measuring sagittal translation in the lumbar vertebral motion segment. An experimental model. Spine. 1990;15(8):741-750
- Frymoyer JW, Cats-Baril WL. An overview of the incidences and costs of low back pain. Orthop Clin North Am 1991;22:263-71
- Burkus JK, Zdeblick TA. Lumbar disc disease A. pathophysiology of lumbar spondylosis and discogenic back pain. In The Adult and Pediatric Spine. (Frymoyer JW, Wiesel SW, An HS, Boden SD, Lauerman WC eds). Lippincott Williams & Wilkins 2003:907
- Muggleton JM, Kondracki M, Allen R. Spinal fusion for lumbar instability: does it have a scientific basis? J Spinal Disord 2000;13:200-4
