Validity of flexicurve and motion capture for measurements of thoracic kyphosis vs standing radiographic measurements

Thoracic kyphosis varies among healthy adults and typically increases with age. Excessive kyphosis (hyperkyphosis) is associated with negative health. Spinal alignment also affects spine loading, with implications for conditions such as vertebral fractures and back pain. Valid measurements of kyphosis are necessary for clinical and research assessment of age‐related posture changes, and to support improved biomechanical understating of spine conditions. Independent validation of non‐radiographic techniques, however, remains limited. The goal of this study was to compare standing radiographic kyphosis measurements with non‐radiographic measurements and predictions of thoracic kyphosis using flexicurve and motion analysis markers, in order to determine their validity. Thirteen non‐radiographic measures of thoracic kyphosis were obtained in each of 40 adult subjects who also underwent standing radiographs of the thoracic spine. Measures included estimates derived by fitting of polynomials or circles to the non‐radiographic data, as well as predictions calculated using previously published methods. Intra‐class correlations (ICC) and root‐mean square errors (RMSEs) were calculated between radiographic and non‐radiographic measures to determine validity. Most non‐radiographic estimates of kyphosis show similar, weak to moderate levels of validity when compared to radiographic measurements, and RMSEs ranging from 8.0° to 20.8°. Unbiased estimates of radiographic measurements with moderate to good ICCs were identified, however, based on marker measurements, and new prediction equations were created with similar validity that also account for age and body habitus. Clinical significance: These non‐radiographic measurements of thoracic kyphosis can be applied to clinical practice or to clinical studies with recognition of specific limitations.