Reliability of motion measurements after total disc replacement: the spike and the fin method

As motion preservation is one of the main postulated advantages after total disc replacement (TDR) of the lumbar spine, the quantification of the mobility after TDR seems of special clinical interest. Yet, the best method to assess range of motion (ROM) after TDR remains unclear. The aim of the study was the calculation of 95%-confidence intervals (95%-C.I.) for the measurement error accompanying: (1) different methods (2) different observers and (3) different levels of training for radiographic motion analysis after TDR. In 12 patients the level L4-L5 and in another 12 patients level L5-S1 were measured with the Cobb and the superimposition method on flexion-extension X-rays after monosegmental TDR. Both methods were adopted as the landmarks used the spikes of the prosthesis instead the endplates (spike method) and the fin of the prosthesis instead the whole vertebral body (fin method). Measurements were performed by two experienced (O-I and O-III) and one inexperienced observer (O-II). The adopted spike and fin method showed a better reliability compared to the reported results of the original Cobb and superimposition method. The method used was not clinically relevant for the intraobserver reliability in the experienced observer (95%-C.I.: +/- 2.0 degrees for the fin and +/- 2.1 for the spike method) and for the interobserver reliability for two experienced observers (95%-C.I.: -2.8 degrees/+2.8 degrees for the fin and -2.9 degrees/+3.1 degrees for the spike method). The intraobserver reliability for the inexperienced observer was inferior for both methods compared to the experienced observer but no clinically relevant differences could be observed in interobserver reliability measures. The spike and fin method are reliable methods for study protocols dealing with angular motion after TDR as clinically valid conclusions can be drawn with an accuracy of about +/- 2 degrees for the same observer and with an accuracy of about +/- 3 degrees for a different observer.