Givens Ritt R, Malka Matan S, Lu Kevin, Mizerik Amber, Bainton Nicole, Zervos Thomas M, Roye Benjamin D, Lenke Lawrence G, Vitale Michael G
Division of Pediatric Orthopedics, Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA.
Och Spine Hospital, Columbia University College of Physicians and Surgeons, New York, NY, USA.
Spine Deform. 2025 Mar;13(2):339-350. doi: 10.1007/s43390-024-00996-8. Epub 2024 Nov 20.
Despite the introduction of "standardized counting" methods, errors in counting spinal levels and subsequent wrong-level surgery (WLS) remain critically important patient safety concerns. Previous work by our group has documented inconsistency in the identification of T12 despite the use of these systems including the Spinal Deformity Study Group (SDSG) conventions. To assist with consistent and repeatable identification of proposed preoperative surgical levels, the current study investigates a new strategy: utilization of a "landmark vertebra". It was hypothesized that individuals using a "landmark vertebra" strategy will achieve high concordance with target level identification between distinct time points as compared to conventional methods defining T12.
Survey participants analyzed 99 pre-op radiographs, identifying and naming a "landmark vertebra" with concise descriptions like "last bilaterally ribbed vertebra." They then noted the proposed lowest instrumented vertebra's (LIV) distance relative to landmark (i.e., one below landmark). After a waiting period, participants used their written descriptions of the landmark and distance to LIV to reidentify these vertebrae. Cohen's Kappa (k) was used to measure intra-rater agreeability. The landmark strategy was compared to our previous work evaluating consistency in defining T12 based on the SDSG system.
All raters showed perfect to near-perfect agreement when re-identifying the landmark and target vertebrae (k = 0.819-1.00; Table 1A). Raters at all training levels had higher agreeability in naming the landmark vertebra and target when compared to raters at similar training levels defining T12 (k = 0.34-0.91; Table 1B). This high agreement across training demonstrates the strategy's versatility and generalizability.
Utilization of a landmark strategy proved to be highly effective in reducing intra-rater variability, with perfect to near-perfect agreement among all raters and consistently higher agreeability when compared to defining T12.
Level II-prospective survey.
尽管引入了“标准化计数”方法，但脊柱节段计数错误及随后的错节手术（WLS）仍是严重的患者安全问题。我们团队之前的研究记录了尽管使用了包括脊柱畸形研究组（SDSG）标准在内的这些系统，但在确定T12时仍存在不一致性。为了协助术前手术节段的一致且可重复识别，本研究调查了一种新策略：使用“标志性椎体”。研究假设是，与定义T12的传统方法相比，采用“标志性椎体”策略的个体在不同时间点之间对目标节段的识别将具有高度一致性。
调查参与者分析了99张术前X光片，通过诸如“最后一个双侧有肋骨的椎体”等简洁描述来识别并命名“标志性椎体”。然后他们记录拟置入内固定最低椎体（LIV）相对于标志性椎体的距离（即低于标志性椎体一个节段）。经过一段等待期后，参与者根据他们对标志性椎体和LIV距离的书面描述重新识别这些椎体。采用Cohen's Kappa（κ）系数来衡量评分者内一致性。将标志性椎体策略与我们之前基于SDSG系统评估定义T12一致性的研究进行比较。
在重新识别标志性椎体和目标椎体时，所有评分者均表现出完全至近乎完全的一致性（κ = 0.819 - 1.00；表1A）。与处于相似培训水平、采用定义T12方法的评分者相比，所有培训水平的评分者在命名标志性椎体和目标椎体时具有更高的一致性（κ = 0.34 - 0.91；表1B）。这种跨培训水平的高度一致性证明了该策略的通用性和可推广性。
事实证明，使用标志性椎体策略在降低评分者内变异性方面非常有效，所有评分者之间具有完全至近乎完全的一致性，并且与定义T12相比始终具有更高的一致性。
II级——前瞻性调查。
