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J Spinal Disord Tech. 2013 Dec 10. [Epub ahead of print]

Assessment of Vertebral Curves Using the Manual Post-It® Technique.

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  • 1*Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 †Weill Cornell Medical College, 1300 York Ave, New York, NY 10021.



A prospective study of a new technique.


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.


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.


We prospectively reviewed anteroposterior (AP) 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) via 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 two methods.


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 two observers was also graded as excellent for both the PACS and Post-It® techniques (all ICCs>0.9).


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.

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