Clinical photographs in the assessment of adult spinal deformity: a comparison to radiographic parameters

2021 ◽  
pp. 1-5
Author(s):  
Devon J. Ryan ◽  
Nicholas D. Stekas ◽  
Ethan W. Ayres ◽  
Mohamed A. Moawad ◽  
Eaman Balouch ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Intraobserver Reliability ◽  
Consecutive Series ◽  
Anatomical Landmarks ◽  
Radiographic Parameters ◽  
Clinical Measures

OBJECTIVE The goal of this study was to reliably predict sagittal and coronal spinal alignment with clinical photographs by using markers placed at easily localized anatomical landmarks. METHODS A consecutive series of patients with adult spinal deformity were enrolled from a single center. Full-length standing radiographs were obtained at the baseline visit. Clinical photographs were taken with reflective markers placed overlying C2, S1, the greater trochanter, and each posterior-superior iliac spine. Sagittal radiographic parameters were C2 pelvic angle (CPA), T1 pelvic angle (TPA), and pelvic tilt. Coronal radiographic parameters were pelvic obliquity and T1 coronal tilt. Linear regressions were performed to evaluate the relationship between radiographic parameters and their photographic “equivalents.” The data were reanalyzed after stratifying the cohort into low–body mass index (BMI) (< 30) and high-BMI (≥ 30) groups. Interobserver and intraobserver reliability was assessed for clinical measures via intraclass correlation coefficients (ICCs). RESULTS A total of 38 patients were enrolled (mean age 61 years, mean BMI 27.4 kg/m2, 63% female). All regression models were significant, but sagittal parameters were more closely correlated to photographic parameters than coronal measurements. TPA and CPA had the strongest associations with their photographic equivalents (both r2 = 0.59, p < 0.001). Radiographic and clinical parameters tended to be more strongly correlated in the low-BMI group. Clinical measures of TPA and CPA had high intraobserver reliability (all ICC > 0.99, p < 0.001) and interobserver reliability (both ICC > 0.99, p < 0.001). CONCLUSIONS The photographic measures of spinal deformity developed in this study were highly correlated with their radiographic counterparts and had high inter- and intraobserver reliability. Clinical photography can not only reduce radiation exposure in patients with adult spinal deformity, but also be used to assess deformity when full-spine radiographs are unavailable.

Novel radiographic parameters for the assessment of total body sagittal alignment in adult spinal deformity patients

2019 ◽  
Vol 31 (3) ◽  
pp. 372-379 ◽  
Author(s):  
Yong-Chan Kim ◽  
Ji Hao Cui ◽  
Ki-Tack Kim ◽  
Gyu-Taek Park ◽  
Keun-Ho Lee ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Sagittal Alignment ◽  
Adult Spinal Deformity ◽  
Intraclass Correlation ◽  
Intraobserver Reliability ◽  
Distance Measures ◽  
Spine Deformity ◽  
Radiographic Parameters ◽  
Patient Reported ◽  
Total Body

OBJECTIVEIn this study, the authors’ goal was to develop and validate novel radiographic parameters that better describe total body sagittal alignment (TBSA).METHODSOne hundred sixty-six consecutive operative spinal deformity patients were evaluated using full-body stereoradiographic imaging. Seven TBSA parameters were measured and then correlated to 6 commonly used spinopelvic measurements. TBSA measures consisted of 4 distance measures relating the cranial center of mass (CCOM) to the sacrum, hips, knees, and ankles, and 3 angular measures relating the CCOM to the hips, knees, and ankles. Furthermore, each TBSA parameter was correlated to patient-reported outcome (PRO) scores using the Oswestry Disability Index (ODI) and Scoliosis Research Society–22 (SRS-22) instruments. Thirty patients were randomly selected for inter- and intraobserver reliability testing of the TBSA parameters using intraclass correlation coefficients (ICCs).RESULTSAll TBSA radiographic parameters demonstrated strong linear correlation with the currently accepted primary measure of sagittal balance, the C7 sagittal vertical axis (r = 0.55–0.96, p < 0.001). Moreover, 5 of 7 TBSA measures correlated strongly with ODI and SRS-22 total scores (r = 0.42–0.51, p < 0.001). Inter- and intraobserver reliability for all TBSA measures was good to excellent (interrater ICC = 0.70–0.98, intrarater ICC = 0.77–1.0).CONCLUSIONSIn spine deformity patients, novel TBSA radiographic parameters correlated well with PROs and with currently utilized spinal sagittal measurements. Inter- and intrarater reliability was high for these novel parameters. This is the first study to propose a reliable method for measuring head-to-toe global spinal alignment.

Spinal Instability Neoplastic Score: An Analysis of Reliability and Validity From the Spine Oncology Study Group

2011 ◽  
Vol 29 (22) ◽  
pp. 3072-3077 ◽  
Author(s):  
Daryl R. Fourney ◽  
Evan M. Frangou ◽  
Timothy C. Ryken ◽  
Christian P. DiPaola ◽  
Christopher I. Shaffrey ◽  
...  
Keyword(s):  
Predictive Validity ◽  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Reliability And Validity ◽  
Correlation Coefficients ◽  
Intraobserver Reliability ◽  
Spinal Tumors ◽  
Spinal Instability ◽  
Study Group ◽  
Reliable Classification

PurposeStandardized indications for treatment of tumor-related spinal instability are hampered by the lack of a valid and reliable classification system. The objective of this study was to determine the interobserver reliability, intraobserver reliability, and predictive validity of the Spinal Instability Neoplastic Score (SINS).MethodsClinical and radiographic data from 30 patients with spinal tumors were classified as stable, potentially unstable, and unstable by members of the Spine Oncology Study Group. The median category for each patient case (consensus opinion) was used as the gold standard for predictive validity testing. On two occasions at least 6 weeks apart, each rater also scored each patient using SINS. Each total score was converted into a three-category data field, with 0 to 6 as stable, 7 to 12 as potentially unstable, and 13 to 18 as unstable.ResultsThe κ statistics for interobserver reliability were 0.790, 0.841, 0.244, 0.456, 0.462, and 0.492 for the fields of location, pain, bone quality, alignment, vertebral body collapse, and posterolateral involvement, respectively. The κ statistics for intraobserver reliability were 0.806, 0.859, 0.528, 0.614, 0.590, and 0.662 for the same respective fields. Intraclass correlation coefficients for inter- and intraobserver reliability of total SINS score were 0.846 (95% CI, 0.773 to 0.911) and 0.886 (95% CI, 0.868 to 0.902), respectively. The κ statistic for predictive validity was 0.712 (95% CI, 0.676 to 0.766).ConclusionSINS demonstrated near-perfect inter- and intraobserver reliability in determining three clinically relevant categories of stability. The sensitivity and specificity of SINS for potentially unstable or unstable lesions were 95.7% and 79.5%, respectively.

scholarly journals Intra- and Interobserver Reliability Comparison of Clinical Gait Analysis Data between Two Gait Laboratories

2020 ◽  
Vol 10 (15) ◽  
pp. 5068
Author(s):  
René Schwesig ◽  
Regina Wegener ◽  
Christof Hurschler ◽  
Kevin Laudner ◽  
Frank Seehaus
Keyword(s):  
Gait Analysis ◽  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Analysis Data ◽  
Individual Variability ◽  
Intraobserver Reliability ◽  
Single Measure ◽  
Ankle Kinematics ◽  
Clinical Gait Analysis

Comparing clinical gait analysis (CGA) data between clinical centers is critical in the treatment and rehabilitation progress. However, CGA protocols and system configurations, as well as choice of marker sets and individual variability during marker attachment, may affect the comparability of data. The aim of this study was to evaluate reliability of CGA data collected between two gait analysis laboratories. Three healthy subjects underwent a standardized CGA protocol at two separate centers. Kinematic data were captured using the same motion capturing systems (two systems, same manufacturer, but different analysis software and camera configurations). The CGA data were analyzed by the same two observers for both centers. Interobserver reliability was calculated using single measure intraclass correlation coefficients (ICC). Intraobserver as well as between-laboratory intraobserver reliability were assessed using an average measure ICC. Interobserver reliability for all joints (ICCtotal = 0.79) was found to be significantly lower (p < 0.001) than intraobserver reliability (ICCtotal = 0.93), but significantly higher (p < 0.001) than between-laboratory intraobserver reliability (ICCtotal = 0.55). Data comparison between both centers revealed significant differences for 39% of investigated parameters. Different hardware and software configurations impact CGA data and influence between-laboratory comparisons. Furthermore, lower intra- and interobserver reliability were found for ankle kinematics in comparison to the hip and knee, particularly for interobserver reliability.

Interobserver Reliability Using the Phonetic Level Evaluation With Severely and Profoundly Hearing-Impaired Children

1991 ◽  
Vol 34 (5) ◽  
pp. 989-999 ◽  
Author(s):  
Stephanie Shaw ◽  
Truman E. Coggins
Keyword(s):  
Interrater Reliability ◽  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Hearing Impaired ◽  
Intraclass Correlation Coefficients ◽  
Assessment Measure ◽  
Impaired Children ◽  
Speech Assessment ◽  
Hearing Impaired Children

This study examines whether observers reliably categorize selected speech production behaviors in hearing-impaired children. A group of experienced speech-language pathologists was trained to score the elicited imitations of 5 profoundly and 5 severely hearing-impaired subjects using the Phonetic Level Evaluation (Ling, 1976). Interrater reliability was calculated using intraclass correlation coefficients. Overall, the magnitude of the coefficients was found to be considerably below what would be accepted in published behavioral research. Failure to obtain acceptably high levels of reliability suggests that the Phonetic Level Evaluation may not yet be an accurate and objective speech assessment measure for hearing-impaired children.

scholarly journals Assessment of reliability and validity of the 5-scale grading system of the point-of-care immunoassay for tear matrix metalloproteinase-9

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Minjeong Kim ◽  
Ja Young Oh ◽  
Seon Ha Bae ◽  
Seung Hyeun Lee ◽  
Won Jun Lee ◽  
...  
Keyword(s):  
Matrix Metalloproteinase ◽  
Calibration Curve ◽  
Point Of Care ◽  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Reliability And Validity ◽  
Correlation Coefficients ◽  
Grading System ◽  
Intraclass Correlation Coefficients ◽  
The Difference

AbstractWe evaluated the reliability and validity of the 5-scale grading system to interpret the point-of-care immunoassay for tear matrix metalloproteinase (MMP)-9. Six observers graded red bands of photographs of the readout window in MMP-9 immunoassay kit (InflammaDry) two times with 2-week interval based on the 5-scale grading system (i.e. grade 0–4). Interobserver and intraobserver reliability were evaluated using intraclass correlation coefficients. The interobserver agreements were analyzed according to the severity of tear MMP-9 expression. To validate the system, a concentration calibration curve was made using MMP-9 solutions with reference concentrations, then the distribution of MMP-9 concentrations was analyzed according to the 5-scale grading system. Both intraobserver and interobserver reliability was excellent. The readout grades were significantly correlated with the quantified colorimetric densities. The interobserver variance of readout grades had no correlation with the severity of the measured densities. The band density continued to increase up to a maximal concentration (i.e. 5000 ng/mL) according to the calibration curve. The difference of grades reflected the change of MMP-9 concentrations sensitively, especially between grade 2 and 4. Together, our data indicate that the subjective 5-scale grading system in the point-of-care MMP-9 immunoassay is an easy and reliable method with acceptable accuracy.

scholarly journals Automatic 3D dense phenotyping provides reliable and accurate shape quantification of the human mandible

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Pieter-Jan Verhelst ◽  
H. Matthews ◽  
L. Verstraete ◽  
F. Van der Cruyssen ◽  
D. Mulier ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Intraclass Correlation ◽  
Three Dimensional ◽  
Correlation Coefficients ◽  
Surface Registration ◽  
Anatomical Landmarks ◽  
Centroid Size ◽  
Intraclass Correlation Coefficients ◽  
Total Variability ◽  
Automatic Phenotyping

AbstractAutomatic craniomaxillofacial (CMF) three dimensional (3D) dense phenotyping promises quantification of the complete CMF shape compared to the limiting use of sparse landmarks in classical phenotyping. This study assesses the accuracy and reliability of this new approach on the human mandible. Classic and automatic phenotyping techniques were applied on 30 unaltered and 20 operated human mandibles. Seven observers indicated 26 anatomical landmarks on each mandible three times. All mandibles were subjected to three rounds of automatic phenotyping using Meshmonk. The toolbox performed non-rigid surface registration of a template mandibular mesh consisting of 17,415 quasi landmarks on each target mandible and the quasi landmarks corresponding to the 26 anatomical locations of interest were identified. Repeated-measures reliability was assessed using root mean square (RMS) distances of repeated landmark indications to their centroid. Automatic phenotyping showed very low RMS distances confirming excellent repeated-measures reliability. The average Euclidean distance between manual and corresponding automatic landmarks was 1.40 mm for the unaltered and 1.76 mm for the operated sample. Centroid sizes from the automatic and manual shape configurations were highly similar with intraclass correlation coefficients (ICC) of > 0.99. Reproducibility coefficients for centroid size were < 2 mm, accounting for < 1% of the total variability of the centroid size of the mandibles in this sample. ICC’s for the multivariate set of 325 interlandmark distances were all > 0.90 indicating again high similarity between shapes quantified by classic or automatic phenotyping. Combined, these findings established high accuracy and repeated-measures reliability of the automatic approach. 3D dense CMF phenotyping of the human mandible using the Meshmonk toolbox introduces a novel improvement in quantifying CMF shape.

Interobserver Reliability and Change in the Sagittal Tibial Tubercle–Trochlear Groove Distance with Increasing Knee Flexion Angles

2021 ◽  
Author(s):  
Ian S. MacLean ◽  
Taylor M. Southworth ◽  
Ian J. Dempsey ◽  
Neal B. Naveen ◽  
Hailey P. Huddleston ◽  
...  
Keyword(s):  
Knee Flexion ◽  
Sagittal Plane ◽  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Flexion Angle ◽  
Tibial Tubercle ◽  
Trochlear Groove ◽  
Knee Flexion Angle ◽  
Intraclass Correlation Coefficients

AbstractThe tibial tubercle–trochlear groove (TT-TG) distance is currently utilized to evaluate knee alignment in patients with patellar instability. Sagittal plane pathology measured by the sagittal tibial tubercle–trochlear groove (sTT-TG) distance has been described in instability but may also be important to consider in patients with cartilage injury. This study aims to (1) describe interobserver reliability of the sTT-TG distance and (2) characterize the change in the sTT-TG distance with respect to changing knee flexion angles. In this cadaveric study, six nonpaired cadaveric knees underwent magnetic resonance imaging (MRI) studies at each of the following degrees of knee flexion: −5, 0, 5, 10, 15, and 20. The sTT-TG distance was measured on the axial T2 sequence. Four reviewers measured this distance for each cadaver at each flexion angle. Intraclass correlation coefficients were calculated to determine interobserver reliability and reproducibility of the sTT-TG measurement. Analysis of variance (ANOVA) tests and Friedman's tests with a Bonferroni's correction were performed for each cadaver to compare sTT-TG distances at each flexion angle. Significance was defined as p < 0.05. There was excellent interobserver reliability of the sTT-TG distance with all intraclass correlation coefficients >0.9. The tibial tubercle progressively becomes more posterior in relation to the trochlear groove (more negative sTT-TG distance) with increasing knee flexion. The sTT-TG distance is a measurement that is reliable between attending surgeons and across training levels. The sTT-TG distance is affected by small changes in knee flexion angle. Awareness of knee flexion angle on MRI is important when this measurement is utilized by surgeons.

3D Biometrics for Hindfoot Alignment Using Weightbearing Computed Tomography

2019 ◽  
Vol 40 (6) ◽  
pp. 720-726 ◽  
Author(s):  
Jian Zhong Zhang ◽  
François Lintz ◽  
Alessio Bernasconi ◽  
Shu Zhang ◽  
Keyword(s):  
Computed Tomography ◽  
Comparative Study ◽  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Level Of Evidence ◽  
Hindfoot Alignment ◽  
Mean Values ◽  
Intraclass Correlation Coefficients ◽  
Prospective Comparative Study

Background: Weightbearing computed tomography (WBCT) is a useful tool for the assessment of hindfoot alignment (HA). Foot ankle offset (FAO) is a recently introduced parameter, determined from WBCT images using semiautomatic software. The aim of this study was to determine the clinical relevance and reproducibility of FAO for the evaluation of HA. Methods: A prospective comparative study was performed on consecutive patients requiring bilateral WBCT between September 2017 and April 2018. Based on the clinical assessment of HA, patients were divided into 3 groups: (1) normal alignment group (G1), (2) valgus (G2), and (3) varus (G3). FAO and long axial view (HACT) were measured on WBCT images, and the groups were compared. The reproducibility of FAO and HACT was determined through intraclass correlation coefficients (ICCs). Regression analysis was performed to investigate the correlation between the 2 methods. Overall, 249 feet (126 patients) were included (G1 = 115, G2 = 78, and G3 = 56 feet). Results: The mean values for FAO and HACT were 1.2% ± 2.8% and 3.9 ± 3.1, respectively, in G1; 8.1% ± 3.7% and 9.7 ± 4.9 in G2; and −6.6% ± 4.8% and −8.2 ± 6.6 in G3. Intra- and interobserver reliability was 0.987 and 0.988 for FAO and 0.949 and 0.949 for HACT, respectively. There was a good linear correlation between HACT and FAO ( R2 = 0.744), with a regression slope of 1.064. Conclusions: WBCT was a useful method for the characterization of HA. FAO was reproducible and correlated well with physical examination. Level of Evidence: Level II, prospective comparative study.

Does MIS Surgery Allow for Shorter Constructs in the Surgical Treatment of Adult Spinal Deformity?

Neurosurgery ◽  
2017 ◽  
Vol 80 (3) ◽  
pp. 489-497 ◽  
Author(s):  
Juan S. Uribe ◽  
Joshua Beckman ◽  
Praveen V. Mummaneni ◽  
David Okonkwo ◽  
Pierce Nunley ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Blood Loss ◽  
Clinical Outcomes ◽  
Spinal Deformity ◽  
Lumbar Lordosis ◽  
Adult Spinal Deformity ◽  
Radiographic Parameters ◽  
Estimated Blood Loss ◽  
Significant Difference ◽  
The Impact

Abstract BACKGROUND: The length of construct can potentially influence perioperative risks in adult spinal deformity (ASD) surgery. A head-to-head comparison between open and minimally invasive surgery (MIS) techniques for treatment of ASD has yet to be performed. OBJECTIVE: To examine the impact of MIS approaches on construct length and clinical outcomes in comparison to traditional open approaches when treating similar ASD profiles. METHODS: Two multicenter databases for ASD, 1 involving MIS procedures and the other open procedures, were propensity matched for clinical and radiographic parameters in this observational study. Inclusion criteria were ASD and minimum 2-year follow-up. Independent t-test and chi-square test were used to evaluate and compare outcomes. RESULTS: A total of 1215 patients were identified, with 84 patients matched in each group. Statistical significance was found for mean levels fused (4.8 for circumferential MIS [cMIS] and 10.1 for open), mean interbody fusion levels (3.6 cMIS and 2.4 open), blood loss (estimated blood loss 488 mL cMIS and 1762 mL open), and hospital length of stay (6.7 days cMIS and 9.7 days open). There was no significant difference in preoperative radiographic parameters or postoperative clinical outcomes (Owestry Disability Index and visual analog scale) between groups. There was a significant difference in postoperative lumbar lordosis (43.3° cMIS and 49.8° open) and pelvic incidence-lumbar lordosis correction (10.6° cMIS and 5.2° open) in the open group. There was no significant difference in reoperation rate between the 2 groups. CONCLUSION: MIS techniques for ASD may reduce construct length, reoperation rates, blood loss, and length of stay without affecting clinical and radiographic outcomes when compared to a similar group of patients treated with open techniques.

scholarly journals High Reproducibility of an Automated Measurement of Mobility for Patients with Axial Spondyloarthritis

2018 ◽  
Vol 45 (10) ◽  
pp. 1383-1388 ◽  
Author(s):  
Juan L. Garrido-Castro ◽  
Rafael Curbelo ◽  
Ramón Mazzucchelli ◽  
María E. Domínguez-González ◽  
Cristina Gonzalez-Navas ◽  
...  
Keyword(s):  
Ankylosing Spondylitis ◽  
Repeated Measures ◽  
Axial Spondyloarthritis ◽  
Activity Index ◽  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Disease Activity Index ◽  
Intraobserver Reliability ◽  
Spinal Mobility ◽  
Video Capture

Objective.Conventional measures of spinal mobility used in the assessment of patients with axial spondyloarthritis (axSpA), such as the Bath Ankylosing Spondylitis Metrology Index and its components, are subject to interobserver variability. The University of Córdoba Ankylosing Spondylitis Metrology Index (UCOASMI) is a validated composite index based on a motion video-capture system, UCOTrack. Our objective was to assess its reproducibility in clinical practice settings.Methods.We carried out an observational study of repeated measures in 3 centers. Video-capture systems were installed and adapted to clinical rooms. Patients with axSpA and stable disease were selected by consecutive stratified sampling [disease duration, sex, and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)]. Intraobserver reliability of the UCOASMI and of conventional measures was tested 3–5 days apart. For interobserver reliability, 3 patients from each center were evaluated in the other centers, within 3–7 days. The intraclass correlation coefficients (ICC) were calculated.Results.Thirty patients were included (73% men, mean age 53 yrs, mean BASDAI 3.0). Interobserver and intraobserver ICC of the UCOASMI was 0.98. Conventional measurements showed lower but adequate reproducibility as well, except for interobserver reliability of lateral flexion (0.41), cervical rotation (0.61), and Schöber test (0.07), and intraobserver reliability of tragus-to-wall distance (0.30).Conclusion.Reproducibility of the UCOASMI seems very high, and apparently more reliable than conventional measures of mobility.

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