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Related Experiment Video

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Assessment of Inter- and Intraobserver Reliability and Accuracy to Evaluate Apical Vertebral Rotation Using Four

Satyajit V Marawar1, Nathaniel R Ordway2, Darryl A Auston3

  • 1Department of Orthopedics, Syracuse Veterans Affairs Medical Center, 800 Irving Ave., Syracuse, NY 13210, USA.

Spine Deformity
|December 28, 2018
PubMed
Summary
This summary is machine-generated.

The Upasani methods for assessing apical vertebral rotation (AVR) are more accurate and reliable than visual estimation or the Nash-Moe system. These findings are crucial for evaluating scoliosis correction success.

Keywords:
Apical vertebral rotationNash-Moe systemObserver reliabilityUpasani methodsVisual x-ray estimation

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Area of Science:

  • Orthopedic Surgery
  • Radiology
  • Spinal Deformity Analysis

Background:

  • Accurate assessment of apical vertebral rotation (AVR) is vital for evaluating the success of interventions and detecting potential loss of correction in scoliotic deformities.
  • Current methods for AVR assessment include visual estimation, the Nash-Moe system, and Upasani's trigonometric and grading systems.

Purpose of the Study:

  • To assess and compare the reliability and accuracy of spine surgeons in evaluating AVR using four distinct methods.
  • To determine the most effective technique for quantifying AVR in scoliotic patients.

Main Methods:

  • A thoracic three-vertebra segment saw bone model was rotated, and anteroposterior radiographs were acquired before and after instrumentation with pedicle screws.
  • Five experienced spinal deformity surgeons evaluated 84 blinded images using visual estimation, Nash-Moe, Upasani trigonometric, and Upasani grading systems.
  • Inter- and intraobserver reliability were calculated using interclass correlation (ICC), and errors were compared to actual rotation.

Main Results:

  • The Upasani trigonometric method demonstrated excellent interobserver reliability (0.935) and good accuracy (average error = 0.9°).
  • The Upasani grading system showed good interobserver reliability (0.829) and higher accuracy (76.74%-80.23%) compared to the Nash-Moe system (38.2%-53.9%).
  • Surgeons' visual estimates had good interobserver reliability (0.898–0.948) but higher average errors (9.5°–12.4°) than the Upasani methods.

Conclusions:

  • Both Upasani methods (trigonometric and grading) offer good reliability and accuracy for AVR assessment.
  • The Upasani methods are superior to subjective visual estimation and the Nash-Moe system for evaluating AVR in scoliotic deformities.
  • These findings support the adoption of Upasani's techniques for more precise scoliosis management.