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.

中文翻译：

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成人脊柱畸形冠状错位的新分类：验证和侧弯X线片的作用。

目的

除了矢状位畸形外，冠状畸形（CM）还会引起成人脊柱畸形（ASD）患者的疼痛，功能受损和美容问题。某些类型的CM在校正后存在重新对齐不足的风险。但是，与矢状位错位相比，CM在文献中受到的关注很少。目的是为我们最近发表的脊柱外科医生中ASD CM分类系统建立可靠性。

方法

15位读者被分配了28个案例进行分类，他们代表CM的全长站立前后位和侧位X线照片。2周后重复该任务，然后参考其他侧面弯曲射线照相（SBR）进行第三次任务。确定了内部，评价人之间的可靠性和SBR的贡献。

结果

主曲线类型，具有第一个修饰符的子类型和具有两个修饰符的子类型的评定者内部可靠性分别计算为0.95、0.86和0.73。评估者间的可靠性平均为0.91、0.75和0.52。分类的四位专家和其他读者之间没有显示评分者内部可靠性的差异。SBR有助于提高第二修饰词的一致性率，或在第一修饰词的等级为A型的情况下更改为适当的等级。

结论

参照完整的脊柱前后位和侧位X线照片，Obeid-CM分类中显示了足够的评分者内部和评分者之间的可靠性。尽管侧面弯曲射线照相不能提高分类的可靠性，但在某些情况下它们有助于更好地理解。外科医生应同时考虑矢状面和冠状面，并且该系统可以为CM做出更好的手术决策。