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A new classification for coronal malalignment in adult spinal deformity: a validation and the role of lateral bending radiographs

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Abstract

Purpose

Coronal malalignment (CM) causes pain, impairment of function and cosmetic problems for adult spinal deformity (ASD) patients in addition to sagittal malalignment. Certain types of CM are at risk of insufficient re-alignment after correction. However, CM has received minimal attention in the literature compared to sagittal malalignment. The purpose was to establish reliability for our recently published classification system of CM in ASD among spine surgeons.

Methods

Fifteen readers were assigned 28 cases for classification, who represented CM with reference to their full-length standing anteroposterior and lateral radiographs. The assignment was repeated 2 weeks later, then a third assignment was done with reference to additional side bending radiographs (SBRs). Intra-, inter-rater reliability and contribution of SBRs were determined.

Results

Intra-rater reliability was calculated as 0.95, 0.86 and 0.73 for main curve types, subtypes with first modifier, and subtypes with two modifiers respectively. Inter-rater reliability averaged 0.91, 0.75 and 0.52. No differences in intra-rater reliability were shown between the four expert elaborators of the classification and other readers. SBRs helped to increase the concordance rate of second modifiers or changed to appropriate grading in cases graded type A in first modifier.

Conclusions

Adequate intra- and inter-rater reliability was shown in the Obeid-CM classification with reference to full spine anteroposterior and lateral radiographs. While side bending radiographs did not improve the classification reliability, they contributed to a better understanding in certain cases. Surgeons should consider both the sagittal and coronal planes, and this system may allow better surgical decision making for CM.

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Authors and Affiliations

  1. Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Place Amélie Raba-Léon, 33076, Bordeaux, France

    Kazunori Hayashi, Louis Boissière, Derek T. Cawley, Daniel Larrieu & Ibrahim Obeid

  2. Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan

    Kazunori Hayashi & Hiroaki Nakamura

  3. ELSAN, Polyclinique Jean Villar, 61 Avenue Maryse Bastié, 33523, Bruges Cedex, France

    Louis Boissière & Ibrahim Obeid

  4. Department of Spine Surgery, Mater Private Hospital, Eccles St, Dublin 7, D07 WKW8, Ireland

    Derek T. Cawley

  5. Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, P.O.Box 4545, Christchurch, 8140, New Zealand

    David Kieser

  6. IRCCS Istituto Ortopedico Galeazzi, Riccardo Galeazzi Street, 4, 20161, Milan, Italy

    Pedro Berjano & Claudio Lamartina

  7. Department of Orthopedic Surgery, Washington University in St. Louis, 660 South Euclid Avenue, Saint Louis, MO, 63110, USA

    Munich Gupta

  8. Department of Orthopedic Surgery, Centre Médico-Chirurgical de Réadaptation Des Massues, 92 rue Edmond Locard, 69322, Lyon Cedex, France

    Clément Silvestre

  9. Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY, 10003, USA

    Themi Protopsaltis

  10. Orthopedic and Spinal Surgery Department, Kingdom Hospital, King Abdul Aziz Rd, Ar Rabi, Riyadh, 13316, Saudi Arabia

    Anouar Bourghli

  11. Spine Surgery Unit, Vall D’Hebron Hospital, Passeig Vall Hebron 119-129, 08035, Barcelona, Spain

    Ferran Pellisé

  12. Department of Orthopaedic Surgery, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK

    Prokopis Annis

  13. Orthopedic Department, School of Medicine, University of Athens, 1 Rimini Street, Haidari, 12462, Athens, Greece

    Elias C. Papadopoulos

  14. Department of Orthopedic Surgery, Saint Joseph University, Rue de Damas, Beirut, Lebanon

    Gaby Kreichati

  15. Spine Surgery Unit, Hospital Universitario La Paz, Paseo de La Castellana, 261, 28046, Madrid, Spain

    Javier Pizones

  16. Department of Neurological Surgery, University of California, 505 Parnassus Ave, Room M779, San Francisco, CA, 94143, USA

    Christopher P. Ames

Authors
  1. Kazunori Hayashi
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  2. Louis Boissière
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  3. Derek T. Cawley
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  4. Daniel Larrieu
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  5. David Kieser
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  6. Pedro Berjano
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  7. Claudio Lamartina
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  8. Munich Gupta
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  9. Clément Silvestre
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  10. Themi Protopsaltis
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  11. Anouar Bourghli
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  12. Ferran Pellisé
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  13. Prokopis Annis
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  14. Elias C. Papadopoulos
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  15. Gaby Kreichati
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  16. Javier Pizones
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  17. Hiroaki Nakamura
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  18. Christopher P. Ames
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  19. Ibrahim Obeid
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Corresponding author

Correspondence to Kazunori Hayashi.

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Hayashi, K., Boissière, L., Cawley, D.T. et al. A new classification for coronal malalignment in adult spinal deformity: a validation and the role of lateral bending radiographs. Eur Spine J 29, 2287–2294 (2020). https://doi.org/10.1007/s00586-020-06513-5

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  • DOI: https://doi.org/10.1007/s00586-020-06513-5

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