Spondylolisthesis: Intra-rater and Inter-rater Reliabilities of Radiographic Sagittal Spinopelvic Parameters Using...

Area of Science:

• Orthopedics
• Radiology
• Spine Surgery

Background:

• Digital radiography and computer-aided analysis are used for developmental spondylolisthesis.
• Prior research indicates poor reliability in manual measurements, limiting clinical utility.

Purpose of the Study:

• To assess intra-rater and inter-rater reliability of spinopelvic measurements.
• To evaluate measurements from Digital Imaging and Communications in Medicine (DICOM) images on a Picture Archiving and Communication System (PACS).

Main Methods:

• Five raters measured spinopelvic images of 30 patients with developmental spondylolisthesis.
• Measurements were repeated after one week to determine intra-rater and inter-rater reliability.
• Analysis included linear and angular measurements, with comparisons to a research system and statistical analysis (ANOVA, kappa).

Main Results:

• Excellent intraclass correlations (ICCs) were found for slip ratio, C7 balance, and pelvic tilt angle.
• Good to excellent ICCs were noted for angular measurements, but reliability decreased when the sacral plate was involved.
• Agreement was poor for sacral doming classification, and its presence reduced measurement reliability.

Conclusions:

• Spinopelvic measurements from DICOM images using commercial PACS tools demonstrate excellent reliability.
• Sacral doming negatively impacts measurement reliability.
• A reliable radiographic classification of spondylolisthesis should prioritize slip ratio, C7 balance, and pelvic tilt.