Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital At New York Presbyterian, New York, NY, USA.
Eur Spine J. 2021 Mar;30(3):661-667. doi: 10.1007/s00586-020-06702-2. Epub 2021 Jan 1.
Preoperative shoulder balance is an important factor in determining the upper instrumented vertebrae (UIV). In adolescent and adult idiopathic scoliosis (AIS/AdIS) patients, we studied the intraobserver and interobserver reliability of spinal surgeons' assessment of preoperative shoulder balance using X-rays (XR) and anterior/posterior photographs.
An observational review of a prospective multicenter database (AIS Lenke Type 1/5/6) and prospective single-institution database (AdIS) was conducted. Ten spine surgeons reviewed AIS cases; 12 spine surgeons reviewed AdIS cases. Surgeons rated the higher shoulder: left/right/same/unsure. Reliability was calculated using Fleiss' kappa coefficient.
Among 145 Type 1 AIS cases, intraobserver reliability was moderate-to-substantial: XR (κ = 0.59), anterior photographs (κ = 0.68), posterior photographs (k = 0.65). Interobserver reliability was fair to moderate for XR (κ = 0.31), anterior photographs (κ = 0.20), and posterior photographs (κ = 0.30). Among 52 Type 5/6 AIS cases, intraobserver reliability was substantial: XR (κ = 0.70), anterior photographs (κ = 0.76), posterior photographs (κ = 0.71). Interobserver reliability was fair to moderate for XR (κ = 0.49), anterior photographs (κ = 0.47), and posterior photographs (κ = 0.36). Among 66 AdIS cases, intraobserver reliability was substantial: XR (κ = 0.68), anterior photographs (κ = 0.67), posterior photographs (κ = 0.69). Interobserver reliability was moderate for XR (κ = 0.45), anterior photographs (κ = 0.43), posterior photographs (κ = 0.49). Within Type 1 AIS patients, attendings had better intraobserver reliabilities compared to fellows using X-rays (κ = 0.61 vs. 0.53), yet no effect of surgeon experience was seen with clinical photographs.
Though surgeons' ability to agree with themselves was moderate to substantial, surgeons' ability to agree with each other was fair to moderate. Combined measures to assess preoperative shoulder balance are needed for UIV selection.
术前肩部平衡是确定上置器械椎（UIV）的重要因素。在青少年特发性脊柱侧凸（AIS/AdIS）患者中，我们研究了脊柱外科医生使用 X 射线（XR）和前后位照片评估术前肩部平衡的观察者内和观察者间可靠性。
对前瞻性多中心数据库（AIS Lenke 1/5/6 型）和前瞻性单中心数据库（AdIS）进行观察性回顾。10 名脊柱外科医生评估 AIS 病例；12 名脊柱外科医生评估 AdIS 病例。外科医生对高肩进行评估：左/右/相同/不确定。使用 Fleiss'kappa 系数计算可靠性。
在 145 例 AIS1 型病例中，观察者内可靠性为中度至高度可靠：XR（κ=0.59），前位照片（κ=0.68），后位照片（κ=0.65）。对于 XR（κ=0.31）、前位照片（κ=0.20）和后位照片（κ=0.30），观察者间可靠性为中度至轻度可靠。在 52 例 AIS5/6 型病例中，观察者内可靠性为高度可靠：XR（κ=0.70），前位照片（κ=0.76），后位照片（κ=0.71）。对于 XR（κ=0.49）、前位照片（κ=0.47）和后位照片（κ=0.36），观察者间可靠性为中度至轻度可靠。在 66 例 AdIS 病例中，观察者内可靠性为高度可靠：XR（κ=0.68），前位照片（κ=0.67），后位照片（κ=0.69）。对于 XR（κ=0.45）、前位照片（κ=0.43）和后位照片（κ=0.49），观察者间可靠性为中度可靠。在 AIS1 型患者中，与 XR 相比，主治医生的观察者内可靠性优于住院医生（κ=0.61 比 0.53），但在临床照片方面，外科医生经验无影响。
尽管外科医生自我评估的一致性为中度至高度可靠，但外科医生之间的评估一致性为中度至轻度可靠。需要综合评估术前肩部平衡，以选择 UIV。
