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Assessment of Vertebral Curves Using the Manual Post-It Technique

Gladnick, Brian P. MD; Schreiber, Joseph J. MD; Ishmael, Chad R. BA; Bjerke-Kroll, Benjamin T. MD; Cunningham, Matthew E. MD, PhD

doi: 10.1097/BSD.0000000000000070

Study Design: A prospective study of a new technique.

Objective: The aims of this study were to report a manual technique for measuring vertebral curves on digital spine radiographs, and to assess the agreement of this technique with that of digital software for measuring vertebral curves.

Summary of Background Data: Modern picture archiving and communication systems (PACS) typically include software for evaluating radiographic measurements. However, in the outpatient spine setting, patients may present with radiographs stored on a physical disc, which may not include software for measuring vertebral curves. Certain smartphone applications may be used to determine curve magnitude; however, the need exists for an accurate manual technique to measure vertebral curves on digital radiographs in the absence of available analytic software or smartphone technology.

Methods: We prospectively reviewed anteroposterior and lateral spine radiographs of 24 spinal deformity patients. Two independent observers measured Cobb angles for: (1) the major coronal curve; (2) the thoracic kyphosis (T2–T12); and (3) the lumbar lordosis (T12–S1). Measurements were made: (1) digitally using our institution’s PACS; and (2) by a manual technique, which involves placement of an adhesive Post-It note directly on the computer screen, transcribing the angle onto the Post-It note with a pencil, and measuring the angle with a handheld goniometer. Intraclass correlation coefficients (ICCs) were calculated to determine the agreement between the 2 methods.

Results: For both observers, the agreement between the digital PACS and manual Post-It techniques was graded as excellent for both coronal and sagittal plane curves (all ICCs>0.9). Interobserver reliability between the 2 observers was also graded as excellent for both the PACS and Post-It techniques (all ICCs>0.9).

Conclusions: The Post-It technique for measuring Cobb angles demonstrated excellent agreement with the PACS system in our series of spinal deformity patients. Curves on digital radiographs can be accurately measured using a convenient manual technique.

*Department of Orthopaedic Surgery, Hospital for Special Surgery

Weill Cornell Medical College, New York, NY

M.E.C. currently receives payment for education/lecturing purposes from the following sources: DePuy/Johnson & Johnson. The remaining authors declare no conflict of interest.

Reprints: Brian P. Gladnick, MD, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 (e-mail:

Received July 17, 2013

Accepted November 27, 2013

© 2017 by Lippincott Williams & Wilkins, Inc.