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Observer reliability in evaluating pedicle screw placement using computed tomography

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Abstract

Pedicle screw insertion in spinal surgery is a demanding technique with potential risks to neurological structures, for example, within the spinal canal. Assessing screw placement in clinical practice has been performed using plain radiographs and/or mainly axial computed tomography (CT) images. Screw placement using CT image reconstructions in multiple planes has been described, but its reliability has yet to be studied. This study aimed at addressing the clinical issue of interobserver and intraobserver reliability in the use of axial and coronal CT images for the assessment of pedicle screw placement. Fifty nine pedicle screws were studied by two experienced radiologists on two separate occasions. Screw placement was classified as “in”, “out” or “questionable”. On average, 88% and 92% of the screws were classified as “in” by the first and second radiologist, respectively. Intraobserver agreement strength was almost perfect for both observers using either axial or coronal images. Interobserver agreement strength was almost perfect (axial) and substantial (coronal) in the first reading and substantial (axial, coronal) in the second reading. Assessing screw placement in more than one CT imaging plane is not only useful but reliable. Routine use may enhance reporting quality of screw placement by surgeons and radiologists.

Résumé

L’insertion des vis pédiculaires dans la chirurgie rachidienne est une technique nécessitant une bonne expérience, avec des risques potentiels, de lésions des structures neurologiques dans le canal rachidien. Le positionnement des vis pédiculaires peut être évalué à l’aide des radiographies ou du scanner avec reconstruction. Le but de cette étude et de ce travail est de réaliser une étude inter observateurs du positionnement des vis pédiculaires en utilisant le scanner. 59 vis pédiculaires ont été étudiées par des radiologues expérimentés et lors de deux épisodes d’analyse séparés. Le placement des vis a été classé en vis à l’intérieur ou à l’extérieur des pédicules ou en position douteuse. 88 et 92% des vis ont été classées respectivement dans le pédicule par le premier et le deuxième radiologue. Il en est de même des différentes lectures. Evaluer la position des vis pédiculaires à l’aide du CT dans plusieurs plans est non seulement utile mais fiable. Les examens pratiqués de routine pourraient améliorer la qualité des rapports sur le positionnement des vis pédiculaires à la fois pour les chirurgiens et pour les radiologues.

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Authors and Affiliations

  1. Department of Orthopedics, Hôpital Orthopédique de la Suisse Romande, Avenue Pierre-Decker 4, CH-1005, Lausanne, Switzerland

    Victor Kosmopoulos & Constantin Schizas

  2. Department of Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

    Nicolas Theumann & Stefano Binaghi

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  1. Victor Kosmopoulos
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  2. Nicolas Theumann
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  3. Stefano Binaghi
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  4. Constantin Schizas
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Correspondence to Victor Kosmopoulos.

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Kosmopoulos, V., Theumann, N., Binaghi, S. et al. Observer reliability in evaluating pedicle screw placement using computed tomography. International Orthopaedics (SICO 31, 531–536 (2007). https://doi.org/10.1007/s00264-006-0230-8

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  • DOI: https://doi.org/10.1007/s00264-006-0230-8

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