Department of Neurosurgery, Spine, Swedish Neuroscience Institute, Seattle, WA.
Department of Neurological Surgery, Cleveland Clinic Foundation, Cleveland, OH.
Spine (Phila Pa 1976). 2018 Apr 15;43(8):E461-E467. doi: 10.1097/BRS.0000000000002498.
Reliability/external validation study.
Investigate inter- and intrarater reliability of the Hart-International Spine Study Group (ISSG) Proximal Junctional Failure Severity Scale (PJFSS) and its correlation with operative revision in patients with proximal junctional failure (PJF).
The Hart-ISSG PJFSS is a validated classification system for PJF. Reliability of the PJFSS has not been assessed.
Sixteen detailed clinical scenarios were assessed using the ISSG PJFSS classification in six categories: neurologic status, axial pain, instrumentation issue, proximal kyphotic angle, level of upper instrumented vertebrae (UIV), and severity of UIV/UIV+1 fracture. Eleven spine surgeons evaluated each case in all six categories during two different assessments, and provided recommendations regarding operative revision or observation for each case. Inter- and intrarater reliability were calculated based on intraclass correlation coefficients.
All intraclass correlation coefficients demonstrated "almost perfect"' (0.817-0.988) inter-rater agreement for both assessments, except UIV/UIV+1 fracture severity during the second assessment, which demonstrated "substantial" agreement' (0.692). Five of six categories had "almost perfect" mean intrarater reliability (0.805-0.981), while "instrumentation issue" demonstrated "substantial" mean agreement (0.757). Inter-rater reliability for recommendation of surgical intervention was "almost perfect" during both assessments (0.911 and 0.922, respectively). Mean PJFSS scores between the two assessments were significantly higher for cases recommended for operative revision (8.43 ± 0.90) versus cases recommended for observation (P < 0.0001).
The ISSG PJFSS is a reliable and repeatable classification system for assessing patients with PJF. Higher PJFSS scales correlate with recommendation for operative revision, extending prior external validation of the PJFSS.
可靠性/外部验证研究。
研究哈特国际脊柱研究组（ISSG）近端交界区失败严重程度分级（PJFSS）的组内和组间可靠性及其与近端交界区失败（PJF）患者手术翻修的相关性。
哈特-ISSG PJFSS 是一种经过验证的 PJF 分类系统。PJFSS 的可靠性尚未得到评估。
使用 ISSG PJFSS 分类对 16 个详细的临床病例进行评估，分为 6 个类别：神经状态、轴向疼痛、器械问题、近端后凸角、上节段椎骨（UIV）水平和 UIV/UIV+1 骨折的严重程度。11 位脊柱外科医生在两次不同评估中对每个病例的所有 6 个类别进行评估，并对每个病例的手术翻修或观察提供建议。基于组内相关系数计算组内和组间可靠性。
两次评估的所有组内相关系数均显示出“几乎完美”（0.817-0.988）的组间一致性，除了第二次评估中的 UIV/UIV+1 骨折严重程度，其显示出“良好”的一致性（0.692）。六个类别中有五个具有“几乎完美”的组内可靠性（0.805-0.981），而“器械问题”则显示出“良好”的组内一致性（0.757）。两次评估的手术干预建议的组间可靠性均为“几乎完美”（分别为 0.911 和 0.922）。建议手术翻修的病例的平均 PJFSS 评分（8.43±0.90）明显高于建议观察的病例（P<0.0001）。
ISSG PJFSS 是一种可靠且可重复的评估 PJF 患者的分类系统。更高的 PJFSS 评分与手术翻修建议相关，扩展了 PJFSS 的先前外部验证。
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