DeFrancesco Christopher J, Pasha Saba, Miller Daniel J, Betz Randal R, Clements David H, Fletcher Nicholas D, Glotzbecker Michael G, Hwang Steven W, Kelly Michael P, Lehman Ronald A, Lonner Baron S, Newton Peter O, Roye Benjamin D, Sponseller Paul D, Upasani Vidyadhar V, Cahill Patrick J
Division of Orthopedics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA.
Institute for Spine and Scoliosis, 3100 Princeton Pike, Lawrenceville, NJ 08648, USA.
Spine Deform. 2018 Nov-Dec;6(6):644-650. doi: 10.1016/j.jspd.2018.03.001.
Survey-based cross-sectional study.
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.
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.
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.
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.
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 II.
基于调查的横断面研究。
描述经验丰富的脊柱外科医生根据X线片手动测量结果选择中立椎（NV）时的观察者间一致性。其次，使用从低剂量立体放射成像（SR）后处理软件（SterEOS 2D/3D）获得的轴向椎体旋转（AVR）值分别指定研究病例中的NV，并比较手动得出的和软件得出的NV指定结果。
此前研究人员曾建议使用诸如Lenke分类、稳定椎水平、终椎水平和NV水平等参数来确定青少年特发性脊柱侧凸（AIS）的融合水平。研究显示这些椎体指定的观察者间可靠性欠佳。SR后处理软件可能是标准化NV指定的有用工具。
对32例患有特发性脊柱侧凸且Lenke 1-4型曲线的受试者进行评估。经验丰富的外科医生（从业年限7至35年）根据术前X线片指定NV。使用Fleiss Kappa统计量对观察者间可靠性进行量化。将外科医生的回答与使用SR后处理软件提供的AVR值做出的NV指定结果进行比较。这些值之间的一致性使用一致百分比进行量化。
外科医生在根据X线片选择NV方面表现出中等一致性（Kappa值为0.444）。外科医生的回答在26.9%的病例中与SR得出的NV一致，在82.1%的病例中与SR得出的NV相差不超过1个椎体水平，在97.5%的病例中与SR得出的NV相差不超过2个椎体水平。外科医生更倾向于选择SR NV远端而非近端的椎体作为NV。
特发性脊柱侧凸中内固定节段选择和治疗结果的变异性可能部分与NV选择的不一致有关。使用SR后处理软件可能为选择NV提供更可靠的方法。
二级。
