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Interrater reliability of three-dimensional reconstruction of the spine

Low-dose stereoradiography for evaluating bracing in adolescent idiopathic scoliosis

Interrater Reliabilität der dreidimensionalen Rekonstruktion der Wirbelsäule

Low-dose-Stereoradiographie zur Beurteilung der Korsetttherapie bei Adoleszenten mit idiopathischer Skoliose

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Abstract

Background

Bracing constitutes the mainstay treatment for mild scoliosis. The 3D reconstruction of the spine using low-dose stereoradiographic imaging (LSI) is increasingly being used to determine the true shape of the deformity and to assess the success of bracing.

Objective

The aim of the study was to validate the measurement of 3D spinopelvic parameters and vertebral rotation in the setting of bracing treatment via a reliability study conducted in adherence to the guidelines for reporting reliability and agreement studies (GRRAS).

Material and methods

Full spine stereoradiographs of patients with adolescent idiopathic scoliosis (AIS) who underwent Chêneau bracing were retrospectively analyzed. The 3D reconstruction was performed by two experienced operators in a blinded manner and randomized order. Rotation of every vertebra was computed in the coronal, sagittal and axial planes. Sagittal spinopelvic parameters were evaluated. All measurements were statistically compared to determine agreement of the measurement of brace correction using the intraclass correlation coefficient (ICC).

Results

In this study, 45 patients (81% females) aged 12.5 ± 2 years were included. The mean absolute difference was less than 3.5° for all measured angles, less than 4 mm for sagittal vertical axis (SVA) and less than 1.5 mm for lateral pelvic shift. The ICC was high for all parameters (ICC >0.81). Despite the overall high reliability, the reliability of axial rotation was lower in the upper and middle thoracic spine and the lower lumbar spine.

Conclusion

Brace wearing during full spine LSI acquisition does not affect spinal measurements. The LSI under bracing treatment produces reliable measurements of spinopelvic parameters as well as vertebral rotation. These reproducible 3D data enable spine surgeons to assess the true shape of the deformity, to quantify rotation of each vertebra and enhance the understanding of the efficacy of bracing treatment.

Zusammenfassung

Hintergrund

Die Korsetttherapie ist die Behandlung für milde idiopathische Skoliosen (AIS). Die 3‑D-Rekonstruktion der Wirbelsäule mithilfe der LSI („low-dose stereoradiographic imaging“) wird zunehmend verwendet, um die tatsächliche Form und das Ausmaß der Deformität zu bestimmen und den Erfolg der Korsetttherapie zu bewerten.

Fragestellung

Die Interraterreliabilität der Wirbelsäulen-3-D-Messungen wurde im Rahmen der Korsetttherapie bei Patienten mit AIS bestimmt. Diese Studie wurde in Anlehnung an die GRRAS (Guidelines for Reporting Reliability and Agreement Studies) durchgeführt.

Material und Methoden

Röntgen-Wirbelsäulenganzaufnahmen (EOS) von 45 AIS-Patienten, die einer Therapie mittels Chêneau-Korsett unterzogen wurden, konnten retrospektiv analysiert werden. 3‑D-Rekonstruktionen wurden durch 2 erfahrene Untersucher erstellt. Beide Untersucher waren in Bezug auf die Patientendaten verblindet, und die Messungen wurden in randomisierter Form durchgeführt. Die Rotation aller Wirbelkörper wurde in allen Ebenen (koronar, sagittal, axial) ermittelt. Die Parameter des sagittalen Profils und die spinopelvinen Parameter wurden gemessen. Alle Messungen wurden statistisch ausgewertet, um die Übereinstimmung (Interraterreliabilität und Reproduzierbarkeit) unter Anwendung des ICC zu bestimmen.

Ergebnisse

In diese Studie wurden 45 Patienten (81 % Frauen) im Alter von 12,5 ± 2 Jahren eingeschlossen. Die mittlere absolute Differenz betrug für alle gemessenen Winkel weniger als 3,5° und für SVA weniger als 4 mm und für den Beckenschiefstand weniger als 1,5 mm. Der ICC lag für alle Parameter hoch (ICC >0,81). Trotz der hohen Gesamt-Zuverlässigkeit war der ICC für die axiale Rotation in der oberen und mittleren Brustwirbelsäule sowie in der unteren Lendenwirbelsäule niedriger.

Schlussfolgerung

Das Korsett hat während der LSI-basierten Rekonstruktion der Wirbelsäule keinen negativen Einfluss auf die Messungen. Die LSI unter Korsetttherapie liefert zuverlässige Messungen der spinopelvinen Parameter sowie der Wirbelkörperrotation. Diese reproduzierbaren 3‑D-Daten ermöglichen es den Wirbelsäulenchirurgen, die tatsächliche Form der Deformität einzuschätzen, die Rotation jedes Wirbels zu quantifizieren und das Verständnis für die Effizienz der Korsettbehandlung zu verbessern.

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Abbreviations

3D:

Three-dimensional

AIS:

Adolescent idiopathic scoliosis

AVR:

Apical vertebral rotation

CT:

Computed tomography

GRRAS:

Guidelines for reporting reliability and agreement studies

ICC:

Intraclass correlation coefficient

LL:

Lumbar lordosis

LSI:

Low-dose stereoradiographic imaging

MRI:

Magnetic resonance imaging

PI:

Pelvic incidence

PT:

Pelvic tilt

SOSORT:

International Scientific Society on Scoliosis Orthopedic and Rehabilitation Treatment

SRS:

Scoliosis Research Society

SS:

Sacral slope

SSA:

Spinosacral angle

SVA:

Sagittal vertical axis

TK:

Thoracic kyphosis

TP:

Transverse plane

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Funding

This study was supported by the Deutsche Arthrose-Hilfe (P398-A326).

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Trauma Surgery and Spinal Cord Injury, Heidelberg University, Schlierbacher Landstr. 200A, 69118, Heidelberg, Germany

    H. Almansour MD, M. Eng, W. Pepke MD & M. Akbar MD

  2. Institute of Medical Biometry and Informatics, Heidelberg University, Heidelberg, Germany

    T. Bruckner PhD

  3. Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany

    J. Rehm MD & D. Spira MD, MBA

Authors
  1. H. Almansour MD, M. Eng
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Correspondence to M. Akbar MD.

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Conflict of interest

H. Almansour, W. Pepke, J. Rehm, T. Bruckner, D. Spira and M. Akbar declare that they have no competing interests.

This article does not contain any experiments conducted on humans or animals. Institutional review board approval was provided (Vote no. S‑378).

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Almansour, H., Pepke, W., Rehm, J. et al. Interrater reliability of three-dimensional reconstruction of the spine. Orthopäde 49, 350–358 (2020). https://doi.org/10.1007/s00132-019-03712-x

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