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Agreement Between Manual and Computerized Designation of Neutral Vertebra in Idiopathic Scoliosis

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An Erratum to this article was published on 01 March 2019

This article has been updated

Abstract

Study Design

Survey-based cross-sectional study.

Objectives

To describe interobserver agreement among experienced spine surgeons in choosing neutral vertebra (NV) based on manual measurements from radiographs. Secondarily, to use axial vertebral rotation (AVR) values obtained from low-dose stereoradiography (SR) post-processing software (SterEOS 2D/3D) to separately designate the NV in subject cases and to compare manually derived and software-derived NV designations.

Summary of Background Data

Investigators have previously suggested that parameters such as Lenke classification, stable vertebra level, end vertebra level, and NV level be used to decide on fusion levels in adolescent idiopathic scoliosis (AIS). Studies have revealed suboptimal interobserver reliability in these vertebral designations. SR post-processing software may represent a useful tool for standardizing NV designation.

Methods

Thirty-two subjects with idiopathic scoliosis and Lenke 1–4 curves were assessed. Experienced surgeons (range of 7–35 years in practice) assigned NV based on preoperative radiographs. Interobserver reliability was quantified using the Fleiss Kappa statistic. Surgeon responses were compared with NV designations made using AVR values provided by SR postprocessing software. Agreement between these values was quantified using percentage agreement.

Results

Surgeons exhibited moderate agreement in choosing NV based on radiographs (Kappa 0.444). Surgeon responses agreed with the SR-derived NV in 26.9% of cases, lay within 1 level in 82.1% of cases, and lay within 2 levels in 97.5% of cases. Surgeons were more likely to choose distal to the SR NV rather than proximal.

Conclusions

Variability in instrumented level selection and outcomes in idiopathic scoliosis may be partially related to inconsistency in selection of the NV. The use of SR post-processing software may provide a more reliable method for choosing NV.

Level of Evidence

Level II.

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Change history

  • 30 December 2019

    The author would like to update the order of author names as follows

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Authors and Affiliations

  1. Division of Orthopedics, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, 19104, Philadelphia, PA, USA

    Christopher J. De Francesco BS, Saba Pasha PhD, Daniel J. Miller MD & Patrick J. Cahill MD

  2. Institute for Spine and Scoliosis, 3100 Princeton Pike, 08648, Lawrenceville, NJ, USA

    Randal R. Betz MD

  3. Cooper University Orthopedics, One Cooper Plaza, 08103, Camden, NJ, USA

    David H. Clements MD

  4. Emory Orthopedics & Spine Center, 59 Executive Park S, 30329, Atlanta, GA, USA

    Nicholas D. Fletcher MD

  5. Orthopedic Center, Boston Children’s Hospital, 300 Longwood Ave, 02115, Boston, MA, USA

    Michael G. Glotzbecker MD

  6. Shriner’s Hospitals for Children, 3551 N Broad St., 19140, Philadelphia, PA, USA

    Steven W. Hwang MD

  7. Washington University Orthopedics, 660 S. Euclid Ave., Campus Box 8233, 63110, St. Louis, MO, USA

    Michael P. Kelly MD, MSc

  8. Columbia Orthopedics, 161 Fort Washington Ave., 2nd Floor, 10032, New York, NY, USA

    Ronald A. Lehman MD & Benjamin D. Roye MD

  9. Scoliosis and Spine Associates, New York, NY 10017, USA, 820 2nd Ave., 10017, New York, NY, USA

    Baron S. Lonner MD

  10. Rady Children’s Hospital, 3020 Children’s Way, 92123, San Diego, CA, USA

    Peter O. Newton MD & Vidyadhar V. Upasani MD

  11. Johns Hopkins Children’s Center, Baltimore, MD 21287, USA, 1800 Orleans St, 21287, Baltimore, MD, USA

    Paul D. Sponseller MD

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  1. Christopher J. De Francesco BS
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  2. Saba Pasha PhD
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  3. Daniel J. Miller MD
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  16. Patrick J. Cahill MD
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Corresponding author

Correspondence to Patrick J. Cahill MD.

Additional information

IRB approval: This study was reviewed and approved by the Children’s Hospital of Philadelphia Institutional Review Board.

Author disclosures: CJD (none), SP (none), DJM (none), RRB (personal fees and nonfinancial support from Abyrx; nonfinancial support from Advanced Vertebral Solutions; personal fees and nonfinancial support from ApiFix; grants and personal fees from DePuy Synthes Spine; personal fees from Electrocore and Globus Medical; nonfinancial support from Medovex, Medtronic, MiMedx, and Orthobond; personal fees and nonfinancial support from Spineguard, outside the submitted work), DHC (personal fees from Synthes and NuVasive; grants and personal fees from DePuy, outside the submitted work), NDF (personal fees from Zimmer, Medtronic, and Medtronic Sofamor Danek, outside the submitted work), MGG (personal fees from Biomet and DePuy, outside the submitted work), SWH (personal fees from Zimmer, outside the submitted work), MPK (none), RAL (personal fees from DePuy, Medtronic, and Stryker, outside the submitted work), BSL (grants and personal fees from DePuy; personal fees from Apifix, Ethicon, and K2M; nonfinancial support from Paradigm Spine and Spine Search; personal fees from Zimmer, outside the submitted work), PON (grants from EOS Imaging; nonfinancial support from Electrocore; grants and personal fees from DePuy Synthes Spine and K2M; grants from MAZOR, Orthopediatrics, and Zimmer, outside the submitted work), BDR (grants from SRS, OMeGA, and POSNA, outside the submitted work), PDS (grants and personal fees from DePuy, personal fees from Globus Medical, outside the submitted work), VSU (personal fees from DePuy and Orthopediatrics, outside the submitted work), PJC (personal fees from Biogen, Inc, outside the submitted work), The Harms Study Group (none).

IRB Approval: The Children’s Hospital of Philadelphia Institutional Review Board exempted this study from oversight.

The authors received no funding for this work.

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De Francesco, C.J., Pasha, S., Miller, D.J. et al. Agreement Between Manual and Computerized Designation of Neutral Vertebra in Idiopathic Scoliosis. Spine Deform 6, 644–650 (2018). https://doi.org/10.1016/j.jspd.2018.03.001

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