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Scientific Articles   |    
Reliability of Radiographic Measures for Infantile Idiopathic Scoliosis
Jacqueline Corona, MD1; James O. Sanders, MD2; Scott J. Luhmann, MD3; Michel Diab, MD4; Michael G. Vitale, MD, MPH4
1 Division of Orthopaedic Surgery, Southern Illinois University School of Medicine, 701 North First Street, Room D220, Springfield, IL 62702. E-mail address: JacquelineCorona@gmail.com
2 Department of Orthopaedics, University of Rochester, 601 Elmwood Avenue, Box 665, Rochester, NY 14642. E-mail address: james_sanders@urmc.rochester.edu
3 Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8233, St. Louis, MO 63110. E-mail address: luhmanns@wustl.edu
4 Division of Pediatric Orthopaedic Surgery, Columbia University Medical Center, Morgan Stanley Children’s Hospital of New York-Presbyterian, 3959 Broadway, CHONY 8 North, New York, NY 10032. E-mail address for M. Diab: drmicheldiab@hotmail.com. E-mail address for M.G. Vitale: mgv1@columbia.edu
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Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, one or more of the authors has had another relationship, or has engaged in another activity, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

  • Disclosure statement for author(s): PDF

Division of Orthopaedic Surgery, Southern Illinois University School of Medicine, 701 North First Street, Room D220, Springfield, IL 62702. E-mail address: JacquelineCorona@gmail.com
Department of Orthopaedics, University of Rochester, 601 Elmwood Avenue, Box 665, Rochester, NY 14642. E-mail address: james_sanders@urmc.rochester.edu
Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8233, St. Louis, MO 63110. E-mail address: luhmanns@wustl.edu
Division of Pediatric Orthopaedic Surgery, Columbia University Medical Center, Morgan Stanley Children’s Hospital of New York-Presbyterian, 3959 Broadway, CHONY 8 North, New York, NY 10032. E-mail address for M. Diab: drmicheldiab@hotmail.com. E-mail address for M.G. Vitale: mgv1@columbia.edu
Investigation performed at the College of Physicians and Surgeons, Columbia University Medical Center, New York, NY

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 Jun 20;94(12):e86 1-8. doi: 10.2106/JBJS.K.00311
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Abstract

Background: 

Radiographic measures such as the rib vertebral angle difference (RVAD), Cobb angle, and space available for the lung (SAL) help to guide treatment and measure treatment effects in patients with infantile idiopathic scoliosis. This study aimed to evaluate the intraobserver and interobserver reliability of these radiographic measures.

Methods: 

Forty-five spine radiographs of skeletally immature patients (age, two months to four years) with infantile idiopathic scoliosis were measured with use of Surgimap software. Three pediatric orthopaedic surgeons and a pediatric orthopaedic fellow identified the major curve apex, rib-vertebra phase, Cobb angle, and end vertebrae and calculated the RVAD and SAL values at two separate time points. Interobserver and intraobserver reliability of the RVAD, Cobb angle, and SAL values were assessed with use of intraclass correlation coefficients (ICCs). Fleiss kappa coefficients were calculated for categorical variables.

Results: 

The RVAD (ICC = 0.86 to 0.92) and Cobb angle (ICC = 0.99) measurements had high reliability. The SAL value had substantial interobserver reliability (ICC = 0.66) and moderate intraobserver reliability (ICC = 0.73). Despite the high agreement for the Cobb angle, the choice of the major curve vertebrae (kappa = 0.19 to 0.39) and apical vertebra varied (kappa = 0.57 to 0.62). Observers were more likely to choose the same apical vertebra in large curves (r = 0.483, p = 0.001). The agreement for the apical rib-vertebra phase was substantial (kappa = 0.67). Paired RVAD measurements fell within ≤10° of each other in 82% of cases, but the remaining 18% of the RVAD measurements showed >10° of variation.

Conclusions: 

Measurements used to guide treatment of infantile idiopathic scoliosis curves were reliable despite standard radiographic measurement error and the difficulty in obtaining quality images in young patients. Clinicians are dependent on seemingly objective radiographic data. The reliability of the Cobb angle and RVAD measurements in infantile scoliosis was high but not devoid of variability that could skew the ability to accurately and reliably suggest the best course of treatment. The SAL value was a less reliable measure. Treatment recommendations for infantile idiopathic scoliosis should rely on the synthesis of objective and clinically subjective data, as variations in radiographic measurements can lead to inconsistencies in management and to inconsistent treatment outcomes.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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