A new classification for coronal malalignment in adult spinal deformity: a validation and the role of lateral bending radiographs

Purpose Coronal malalignment (CM) causes pain, impairment of function and cosmetic problems for adult spinal deformity (ASD) patients in addition to sagittal malalignment. Certain types of CM are at risk of insufficient re-alignment after correction. However, CM has received minimal attention in the...

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Veröffentlicht in:European spine journal 2020-09, Vol.29 (9), p.2287-2294
Hauptverfasser: Hayashi, Kazunori, Boissière, Louis, Cawley, Derek T., Larrieu, Daniel, Kieser, David, Berjano, Pedro, Lamartina, Claudio, Gupta, Munich, Silvestre, Clément, Protopsaltis, Themi, Bourghli, Anouar, Pellisé, Ferran, Annis, Prokopis, Papadopoulos, Elias C., Kreichati, Gaby, Pizones, Javier, Nakamura, Hiroaki, Ames, Christopher P., Obeid, Ibrahim
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container_end_page 2294
container_issue 9
container_start_page 2287
container_title European spine journal
container_volume 29
creator Hayashi, Kazunori
Boissière, Louis
Cawley, Derek T.
Larrieu, Daniel
Kieser, David
Berjano, Pedro
Lamartina, Claudio
Gupta, Munich
Silvestre, Clément
Protopsaltis, Themi
Bourghli, Anouar
Pellisé, Ferran
Annis, Prokopis
Papadopoulos, Elias C.
Kreichati, Gaby
Pizones, Javier
Nakamura, Hiroaki
Ames, Christopher P.
Obeid, Ibrahim
description Purpose Coronal malalignment (CM) causes pain, impairment of function and cosmetic problems for adult spinal deformity (ASD) patients in addition to sagittal malalignment. Certain types of CM are at risk of insufficient re-alignment after correction. However, CM has received minimal attention in the literature compared to sagittal malalignment. The purpose was to establish reliability for our recently published classification system of CM in ASD among spine surgeons. Methods Fifteen readers were assigned 28 cases for classification, who represented CM with reference to their full-length standing anteroposterior and lateral radiographs. The assignment was repeated 2 weeks later, then a third assignment was done with reference to additional side bending radiographs (SBRs). Intra-, inter-rater reliability and contribution of SBRs were determined. Results Intra-rater reliability was calculated as 0.95, 0.86 and 0.73 for main curve types, subtypes with first modifier, and subtypes with two modifiers respectively. Inter-rater reliability averaged 0.91, 0.75 and 0.52. No differences in intra-rater reliability were shown between the four expert elaborators of the classification and other readers. SBRs helped to increase the concordance rate of second modifiers or changed to appropriate grading in cases graded type A in first modifier. Conclusions Adequate intra- and inter-rater reliability was shown in the Obeid-CM classification with reference to full spine anteroposterior and lateral radiographs. While side bending radiographs did not improve the classification reliability, they contributed to a better understanding in certain cases. Surgeons should consider both the sagittal and coronal planes, and this system may allow better surgical decision making for CM.
doi_str_mv 10.1007/s00586-020-06513-5
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Certain types of CM are at risk of insufficient re-alignment after correction. However, CM has received minimal attention in the literature compared to sagittal malalignment. The purpose was to establish reliability for our recently published classification system of CM in ASD among spine surgeons. Methods Fifteen readers were assigned 28 cases for classification, who represented CM with reference to their full-length standing anteroposterior and lateral radiographs. The assignment was repeated 2 weeks later, then a third assignment was done with reference to additional side bending radiographs (SBRs). Intra-, inter-rater reliability and contribution of SBRs were determined. Results Intra-rater reliability was calculated as 0.95, 0.86 and 0.73 for main curve types, subtypes with first modifier, and subtypes with two modifiers respectively. Inter-rater reliability averaged 0.91, 0.75 and 0.52. No differences in intra-rater reliability were shown between the four expert elaborators of the classification and other readers. SBRs helped to increase the concordance rate of second modifiers or changed to appropriate grading in cases graded type A in first modifier. Conclusions Adequate intra- and inter-rater reliability was shown in the Obeid-CM classification with reference to full spine anteroposterior and lateral radiographs. While side bending radiographs did not improve the classification reliability, they contributed to a better understanding in certain cases. Surgeons should consider both the sagittal and coronal planes, and this system may allow better surgical decision making for CM.</description><identifier>ISSN: 0940-6719</identifier><identifier>EISSN: 1432-0932</identifier><identifier>DOI: 10.1007/s00586-020-06513-5</identifier><identifier>PMID: 32588234</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Classification ; Decision making ; Medicine ; Medicine &amp; Public Health ; Neurosurgery ; Original Article ; Radiography ; Surgeons ; Surgical Orthopedics</subject><ispartof>European spine journal, 2020-09, Vol.29 (9), p.2287-2294</ispartof><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2020</rights><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2020.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-7aeafaaf3ddcf50a1d4d244f808943ae83bcf498f0126b61382971855ca17af43</citedby><cites>FETCH-LOGICAL-c375t-7aeafaaf3ddcf50a1d4d244f808943ae83bcf498f0126b61382971855ca17af43</cites><orcidid>0000-0002-2765-822X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00586-020-06513-5$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00586-020-06513-5$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32588234$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hayashi, Kazunori</creatorcontrib><creatorcontrib>Boissière, Louis</creatorcontrib><creatorcontrib>Cawley, Derek T.</creatorcontrib><creatorcontrib>Larrieu, Daniel</creatorcontrib><creatorcontrib>Kieser, David</creatorcontrib><creatorcontrib>Berjano, Pedro</creatorcontrib><creatorcontrib>Lamartina, Claudio</creatorcontrib><creatorcontrib>Gupta, Munich</creatorcontrib><creatorcontrib>Silvestre, Clément</creatorcontrib><creatorcontrib>Protopsaltis, Themi</creatorcontrib><creatorcontrib>Bourghli, Anouar</creatorcontrib><creatorcontrib>Pellisé, Ferran</creatorcontrib><creatorcontrib>Annis, Prokopis</creatorcontrib><creatorcontrib>Papadopoulos, Elias C.</creatorcontrib><creatorcontrib>Kreichati, Gaby</creatorcontrib><creatorcontrib>Pizones, Javier</creatorcontrib><creatorcontrib>Nakamura, Hiroaki</creatorcontrib><creatorcontrib>Ames, Christopher P.</creatorcontrib><creatorcontrib>Obeid, Ibrahim</creatorcontrib><title>A new classification for coronal malalignment in adult spinal deformity: a validation and the role of lateral bending radiographs</title><title>European spine journal</title><addtitle>Eur Spine J</addtitle><addtitle>Eur Spine J</addtitle><description>Purpose Coronal malalignment (CM) causes pain, impairment of function and cosmetic problems for adult spinal deformity (ASD) patients in addition to sagittal malalignment. Certain types of CM are at risk of insufficient re-alignment after correction. However, CM has received minimal attention in the literature compared to sagittal malalignment. The purpose was to establish reliability for our recently published classification system of CM in ASD among spine surgeons. Methods Fifteen readers were assigned 28 cases for classification, who represented CM with reference to their full-length standing anteroposterior and lateral radiographs. The assignment was repeated 2 weeks later, then a third assignment was done with reference to additional side bending radiographs (SBRs). Intra-, inter-rater reliability and contribution of SBRs were determined. Results Intra-rater reliability was calculated as 0.95, 0.86 and 0.73 for main curve types, subtypes with first modifier, and subtypes with two modifiers respectively. Inter-rater reliability averaged 0.91, 0.75 and 0.52. No differences in intra-rater reliability were shown between the four expert elaborators of the classification and other readers. SBRs helped to increase the concordance rate of second modifiers or changed to appropriate grading in cases graded type A in first modifier. Conclusions Adequate intra- and inter-rater reliability was shown in the Obeid-CM classification with reference to full spine anteroposterior and lateral radiographs. While side bending radiographs did not improve the classification reliability, they contributed to a better understanding in certain cases. 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Certain types of CM are at risk of insufficient re-alignment after correction. However, CM has received minimal attention in the literature compared to sagittal malalignment. The purpose was to establish reliability for our recently published classification system of CM in ASD among spine surgeons. Methods Fifteen readers were assigned 28 cases for classification, who represented CM with reference to their full-length standing anteroposterior and lateral radiographs. The assignment was repeated 2 weeks later, then a third assignment was done with reference to additional side bending radiographs (SBRs). Intra-, inter-rater reliability and contribution of SBRs were determined. Results Intra-rater reliability was calculated as 0.95, 0.86 and 0.73 for main curve types, subtypes with first modifier, and subtypes with two modifiers respectively. Inter-rater reliability averaged 0.91, 0.75 and 0.52. No differences in intra-rater reliability were shown between the four expert elaborators of the classification and other readers. SBRs helped to increase the concordance rate of second modifiers or changed to appropriate grading in cases graded type A in first modifier. Conclusions Adequate intra- and inter-rater reliability was shown in the Obeid-CM classification with reference to full spine anteroposterior and lateral radiographs. While side bending radiographs did not improve the classification reliability, they contributed to a better understanding in certain cases. Surgeons should consider both the sagittal and coronal planes, and this system may allow better surgical decision making for CM.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>32588234</pmid><doi>10.1007/s00586-020-06513-5</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-2765-822X</orcidid></addata></record>
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subjects Classification
Decision making
Medicine
Medicine & Public Health
Neurosurgery
Original Article
Radiography
Surgeons
Surgical Orthopedics
title A new classification for coronal malalignment in adult spinal deformity: a validation and the role of lateral bending radiographs
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