@article{8edc378a825e439cbc2080b8320dcf40,
title = "Agreement Between Manual and Computerized Designation of Neutral Vertebra in Idiopathic Scoliosis",
abstract = "Study Design: Survey-based cross-sectional study. Objectives: To describe interobserver agreement among experienced spine surgeons in choosing neutral vertebra (NV) based on manual measurements from radiographs. Secondarily, to use axial vertebral rotation (AVR) values obtained from low-dose stereoradiography (SR) post-processing software (SterEOS 2D/3D) to separately designate the NV in subject cases and to compare manually derived and software-derived NV designations. Summary of Background Data: Investigators have previously suggested that parameters such as Lenke classification, stable vertebra level, end vertebra level, and NV level be used to decide on fusion levels in adolescent idiopathic scoliosis (AIS). Studies have revealed suboptimal interobserver reliability in these vertebral designations. SR post-processing software may represent a useful tool for standardizing NV designation. Methods: Thirty-two subjects with idiopathic scoliosis and Lenke 1–4 curves were assessed. Experienced surgeons (range of 7–35 years in practice) assigned NV based on preoperative radiographs. Interobserver reliability was quantified using the Fleiss Kappa statistic. Surgeon responses were compared with NV designations made using AVR values provided by SR postprocessing software. Agreement between these values was quantified using percentage agreement. Results: Surgeons exhibited moderate agreement in choosing NV based on radiographs (Kappa 0.444). Surgeon responses agreed with the SR-derived NV in 26.9% of cases, lay within 1 level in 82.1% of cases, and lay within 2 levels in 97.5% of cases. Surgeons were more likely to choose distal to the SR NV rather than proximal. Conclusions: Variability in instrumented level selection and outcomes in idiopathic scoliosis may be partially related to inconsistency in selection of the NV. The use of SR post-processing software may provide a more reliable method for choosing NV. Level of Evidence: Level II.",
keywords = "Computer-assisted Planning, Neutral Vertebra, Stereoradiography, Variability",
author = "{the Harms Study Group} and DeFrancesco, {Christopher J.} and Saba Pasha and Miller, {Daniel J.} and Betz, {Randal R.} and Clements, {David H.} and Fletcher, {Nicholas D.} and Glotzbecker, {Michael G.} and Hwang, {Steven W.} and Kelly, {Michael P.} and Lehman, {Ronald A.} and Lonner, {Baron S.} and Newton, {Peter O.} and Roye, {Benjamin D.} and Sponseller, {Paul D.} and Upasani, {Vidyadhar V.} and Cahill, {Patrick J.}",
note = "Funding Information: Author disclosures: CJD (none), SP (none), DJM (none), RRB (personal fees and nonfinancial support from Abyrx; nonfinancial support from Advanced Vertebral Solutions; personal fees and nonfinancial support from ApiFix; grants and personal fees from DePuy Synthes Spine; personal fees from Electrocore and Globus Medical; nonfinancial support from Medovex, Medtronic, MiMedx, and Orthobond; personal fees and nonfinancial support from Spineguard, outside the submitted work), DHC (personal fees from Synthes and NuVasive; grants and personal fees from DePuy, outside the submitted work), NDF (personal fees from Zimmer, Medtronic, and Medtronic Sofamor Danek, outside the submitted work), MGG (personal fees from Biomet and DePuy, outside the submitted work), SWH (personal fees from Zimmer, outside the submitted work), MPK (none), RAL (personal fees from DePuy, Medtronic, and Stryker, outside the submitted work), BSL (grants and personal fees from DePuy; personal fees from Apifix, Ethicon, and K2M; nonfinancial support from Paradigm Spine and Spine Search; personal fees from Zimmer, outside the submitted work), PON (grants from EOS Imaging; nonfinancial support from Electrocore; grants and personal fees from DePuy Synthes Spine and K2M; grants from MAZOR, Orthopediatrics, and Zimmer, outside the submitted work), BDR (grants from SRS, OMeGA, and POSNA, outside the submitted work), PDS (grants and personal fees from DePuy, personal fees from Globus Medical, outside the submitted work), VSU (personal fees from DePuy and Orthopediatrics, outside the submitted work), PJC (personal fees from Biogen, Inc, outside the submitted work), The Harms Study Group (none). Publisher Copyright: {\textcopyright} 2018 Scoliosis Research Society",
year = "2018",
month = nov,
day = "1",
doi = "10.1016/j.jspd.2018.03.001",
language = "English (US)",
volume = "6",
pages = "644--650",
journal = "Spine deformity",
issn = "2212-134X",
publisher = "Elsevier BV",
number = "6",
}