Consistency validation of the determination of the upper end, neutral, and stable vertebrae of degenerative lumbar scoliosis by upright long-cassette radiographs
Liang Xiao, Wang Hui, Xu Jiaxin, Sun Jiayuan, Liu Qingtao, Yang Dalong, Ding Wenyuan
Department of Spine Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
Abstract：Objective This study aimed to investigate the concordance and agreement rates in determining the upper end, neutral, and stable vertebrae on standing full-spine radiographs in patients with degenerative lumbar scoliosis (DLS). Methods The retrospective cross-sectional study was conducted. Clinical data of 70 patients with DLS who underwent surgical treatment in the Department of Spine Surgery in the Third Hospital of Hebei Medical University from January 2021 to October 2022 were included in this study, including 26 males and 44 females, aged 51-78 (61.5±8.1) years. The spine surgery deputy chief physician (observer 1), attending physician (observer 2), and resident physician (observer 3) judged the upper end, neutral, and stable vertebrae of the main bend in the standing full-length orthopantomogram of the spine in 70 patients, respectively. Each observer made two judgments, with an interval of 2 days. The interobserver agreement test was based on the results of the first judgment to determine. The results and consistency rate of the three physicians in judging the upper, neutral, and stable vertebrae of the lumbar main curvature in patients with DLS were recorded. Cohen's Kappa correlation coefficient was used to evaluate the intraobserver agreement among the three observers, and Fleiss's Kappa correlation coefficient was used to evaluate the interobserver agreement. The intraobserver agreement rate was the percentage of the observer's own judgments that agreed exactly on two occasions. The interobserver agreement rate is the percentage of three observers who agree that the results are identical. Results The intraobserver consistency results for the upper end, neutral, and stable vertebrae were as follows: the Kappa values for observer 1 were 0.766, 0.807, and 0.837, with agreement rates of 87.1%, 90.1%, and 92.9%, respectively; the Kappa values for observer 2 were 0.733, 0.701, and 0.727, with agreement rates of 87.1%, 84.3%, and 88.5%, respectively; the Kappa values for observer 3 were 0.661, 0.639, and 0.671, with agreement rates of 82.5%, 81.4%, and 81.4%, respectively. The consistency of the upper end vertebra was good among all 3 observers. To determine the neutral and stable vertebrae, observer 1 was excellent, observer 2 and observer 3 were good. The consistency rates of upper, neutral, and stable vertebrae among the intraobserver were judged to be observer 1 > observer 2 > observer 3 from high to low. The Kappa values for determining the consistency of upper, neutral, and stable vertebrae among the interobserver were 0.448, 0.200, and 0.353, respectively, and the consistency rates were 58.6%, 38.6%, and 54.3%, respectively. The consistency of upper end vertebrae was general among observers, the consistency of stable vertebrae was poor, and the consistency of neutral vertebrae was poor. The consistency rate of the upper end, neutral and stable vertebrae was determined to be the upper end vertebra > stable vertebra > neutral vertebrae from high to low. Conclusion The upper, neutral, and stable vertebrae of the lumbar main curvature of patients with DLS are determined on the standing spine X-ray, and the internal consistency of the intraobserver is good. In addition, the consistency rate is high. However, the consistency and consistency rate of interobserver judgment are not ideal, which may be due to the different experience and level of interobserver.
梁晓, 王辉, 徐佳欣, 孙家元, 刘庆涛, 杨大龙, 丁文元. 基于站立位全脊柱X线片判定退变性腰椎侧凸上端椎、中立椎、稳定椎的一致性验证[J]. 中华解剖与临床杂志, 2023, 28(10): 662-666.
Liang Xiao, Wang Hui, Xu Jiaxin, Sun Jiayuan, Liu Qingtao, Yang Dalong, Ding Wenyuan. Consistency validation of the determination of the upper end, neutral, and stable vertebrae of degenerative lumbar scoliosis by upright long-cassette radiographs. Chinese Journal of Anatomy and Clinics, 2023, 28(10): 662-666.
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2023, Vol. 28 
