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Assessment of Inter- and Intraobserver Reliability and Accuracy to Evaluate Apical Vertebral Rotation Using Four Methods: An Experimental Study Using a Saw Bone Model

  • Basic Science
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Abstract

Study Design

After placing a thoracic three-vertebra segment saw bones model on a standardized turntable, a series of anteroposterior (AP) radiographs were obtained and then set in increments to 90° rotation. Then the specimen was instrumented with 35-mm pedicle screws bilaterally and the rotation process and image acquisition were repeated.

Objective

Assess reliability and accuracy of spine surgeons evaluating apical vertebral rotation (AVR) through surgeon’s visual x-ray estimation, Nash-Moe system, Upasani trigonometric method, and Upasani grading system.

Background Context

Accurate assessment of AVR is one measure surgeons can evaluate the success of intervention and potential loss of correction in scoliotic deformities.

Methods

Eighty-four representative images of uninstrumented and instrumented vertebral segments were blinded. AVR was estimated by five experienced spinal deformity surgeons using the four techniques. The surgeons’ grading, estimates, and errors compared to actual rotation were calculated. Inter- and intraobserver reliability were calculated using interclass correlation (ICC).

Results

Each surgeon’s error for simple visual estimation for uninstrumented segments was 8.7° to 17.4° (average error = 12.4°), and for instrumented segments it was 7.7° to 11.3° (average error = 9.5°). Error for the Upasani trigonometric method was −6.7° to 11.6° (average error = 0.9°). There was relatively poor accuracy for Nash-Moe system (38.2%–53.9%) compared with the Upasani grading system (76.74%–80.23%). Interobserver reliability using the Nash-Moe method was good (0.844), with intraobserver reliability from fair to excellent (0.684–0.949). Interobserver reliability for the Upasani grading method was good (0.829), with intraobserver reliability from fair to good (0.751–0.869). We found excellent interobserver reliability for Upasani trigonometric classification (0.935) with fair to excellent intraobserver reliability (0.775–0.991). The interobserver reliability of surgeons’ visual estimates was good (0.898) and the intraobserver reliability from good to excellent (0.866–0.99) without pedicle screws, and interobserver reliability was excellent (0.948) and intraobserver reliability also excellent (0.959–0.986) with pedicle screws.

Conclusions

We confirm that both techniques described by Upasani have good reliability and accuracy, appearing more accurate than surgeon’s visual estimates or Nash-Moe system.

Level of Evidence

Level III.

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Authors and Affiliations

  1. Department of Orthopedics, Syracuse Veterans Affairs Medical Center, 800 Irving Ave., Syracuse, NY, 13210, USA

    Satyajit V. Marawar MD

  2. Department of Orthopedic Surgery, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA

    Nathaniel R. Ordway MS/PE, Swamy Kurra MBBS, Richard A. Tallarico MD, Danielle A. Katz MD, Kathryn Palomino MD & William F. Lavelle MD

  3. Orthopedic Trauma, Hughston Clinic, Orange Park Medical Center, 2001 Kingsley Ave, Orange Park, FL, 32073, USA

    Darryl A. Auston MD, PhD

  4. Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, 766 Irving Ave, Syracuse, NY, 13210, USA

    Dongliang Wang PhD

  5. Department of Neurosurgery, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA

    Venita M. Simpson MD

  6. Warren Alpert School of Medicine at Brown University, 222 Richmond St, Providence, RI, 02903, USA

    Mark Palumbo MD

Authors
  1. Satyajit V. Marawar MD
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  2. Nathaniel R. Ordway MS/PE
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  3. Darryl A. Auston MD, PhD
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  4. Swamy Kurra MBBS
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  5. Dongliang Wang PhD
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  6. Venita M. Simpson MD
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  7. Richard A. Tallarico MD
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  8. Danielle A. Katz MD
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  9. Kathryn Palomino MD
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  10. Mark Palumbo MD
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  11. William F. Lavelle MD
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Corresponding author

Correspondence to William F. Lavelle MD.

Additional information

Author disclosures: SVM (none), NROrdway (grants from Premier Orthopedic Solutions, outside the submitted work), DAA (none), SK (none), DW (none), VMS (none), RAT (personal fees from Stryker, grants from Vertiflex, outside the submitted work), DAK (other from AAOS, American College of Surgeons, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Johnson & Johnson, Merck, Novartis, Procter & Gamble, Roche, and Sanofi-Aventis, outside the submitted work), KP (none), MP (personal fees from Stryker, Globus, Orthofix, Spineart, and Various Law Firms, outside the submitted work), WFL (other from SAS, Prosydian, Innovasis, 4Web, and Cardan Robotics; grants from DePuy Spine, Signus, Spinal Kinetics, K2M, Vertebral Technologies, Synthes Spine, Medtronic, IntegraLife, Providence Technologies, Stryker, Vertiflex, and Amedica, outside the submitted work).

This study required no IRB approval.

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Marawar, S.V., Ordway, N.R., Auston, D.A. et al. Assessment of Inter- and Intraobserver Reliability and Accuracy to Evaluate Apical Vertebral Rotation Using Four Methods: An Experimental Study Using a Saw Bone Model. Spine Deform 7, 11–17 (2019). https://doi.org/10.1016/j.jspd.2018.06.009

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  • DOI: https://doi.org/10.1016/j.jspd.2018.06.009

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