Inter-and intra-rater reliability of the hart-ISSG proximal junctional failure severity scale

Robert A. Hart; Farbod Rastegar; Alec Contag; Marie Kane; Alan Daniels; Eric Klineberg; Robert Eastlack; Justin S. Smith; Richard Hostin; D. Kojo Hamilton; Jeffrey L. Gum; Douglas C. Burton; Justin K. Sheer; Christopher Ames; Frank Schwab; Virginie Lafage; Shay Bess; Christopher Shaffrey; Khaled Kebaish

doi:10.1097/BRS.0000000000002498

Inter-and intra-rater reliability of the hart-ISSG proximal junctional failure severity scale

Robert A. Hart, Farbod Rastegar, Alec Contag, Marie Kane, Alan Daniels, Eric Klineberg, Robert Eastlack, Justin S. Smith, Richard Hostin, D. Kojo Hamilton, Jeffrey L. Gum, Douglas C. Burton, Justin K. Sheer, Christopher Ames, Frank Schwab, Virginie Lafage, Shay Bess, Christopher Shaffrey, Khaled Kebaish

School of Medicine

Research output: Contribution to journal › Article › peer-review

3 Scopus citations

Abstract

Study Design. Reliability/external validation study. Objective. Investigate inter- and intrarater reliability of the Hart-International Spine Study Group (ISSG) Proximal Junctional Failure Severity Scale (PJFSS) and its correlation with operative revision in patients with proximal junctional failure (PJF). Summary of Background Data. The Hart-ISSG PJFSS is a validated classification system for PJF. Reliability of the PJFSS has not been assessed. Methods. Sixteen detailed clinical scenarios were assessed using the ISSG PJFSS classification in six categories: neurologic status, axial pain, instrumentation issue, proximal kyphotic angle, level of upper instrumented vertebrae (UIV), and severity of UIV/UIV+1 fracture. Eleven spine surgeons evaluated each case in all six categories during two different assessments, and provided recommendations regarding operative revision or observation for each case. Inter- and intrarater reliability were calculated based on intraclass correlation coefficients. Results. All intraclass correlation coefficients demonstrated "almost perfect"' (0.817-0.988) inter-rater agreement for both assessments, except UIV/UIV+1 fracture severity during the second assessment, which demonstrated "substantial" agreement' (0.692). Five of six categories had "almost perfect" mean intrarater reliability (0.805-0.981), while "instrumentation issue" demonstrated "substantial" mean agreement (0.757). Inter-rater reliability for recommendation of surgical intervention was "almost perfect" during both assessments (0.911 and 0.922, respectively). Mean PJFSS scores between the two assessments were significantly higher for cases recommended for operative revision (8.43±0.90) versus cases recommended for observation (P<0.0001). Conclusion. The ISSG PJFSS is a reliable and repeatable classification system for assessing patients with PJF. Higher PJFSS scales correlate with recommendation for operative revision, extending prior external validation of the PJFSS.

Original language	English (US)
Pages (from-to)	E461-E467
Journal	Spine
Volume	43
Issue number	8
DOIs	https://doi.org/10.1097/BRS.0000000000002498
State	Published - Apr 15 2018

Keywords

Adult spinal deformity
Complications
Proximal junctional failure
Proximal junctional kyphosis
Validation

ASJC Scopus subject areas

Clinical Neurology
Orthopedics and Sports Medicine

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10.1097/BRS.0000000000002498

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Hart, R. A., Rastegar, F., Contag, A., Kane, M., Daniels, A., Klineberg, E., Eastlack, R., Smith, J. S., Hostin, R., Hamilton, D. K., Gum, J. L., Burton, D. C., Sheer, J. K., Ames, C., Schwab, F., Lafage, V., Bess, S., Shaffrey, C., & Kebaish, K. (2018). Inter-and intra-rater reliability of the hart-ISSG proximal junctional failure severity scale. Spine, 43(8), E461-E467. https://doi.org/10.1097/BRS.0000000000002498

Hart, RA, Rastegar, F, Contag, A, Kane, M, Daniels, A, Klineberg, E, Eastlack, R, Smith, JS, Hostin, R, Hamilton, DK, Gum, JL, Burton, DC, Sheer, JK, Ames, C, Schwab, F, Lafage, V, Bess, S, Shaffrey, C & Kebaish, K 2018, 'Inter-and intra-rater reliability of the hart-ISSG proximal junctional failure severity scale', Spine, vol. 43, no. 8, pp. E461-E467. https://doi.org/10.1097/BRS.0000000000002498

@article{a7babdc7cd084f0b886d2ca446485d0f,

title = "Inter-and intra-rater reliability of the hart-ISSG proximal junctional failure severity scale",

abstract = "Study Design. Reliability/external validation study. Objective. Investigate inter- and intrarater reliability of the Hart-International Spine Study Group (ISSG) Proximal Junctional Failure Severity Scale (PJFSS) and its correlation with operative revision in patients with proximal junctional failure (PJF). Summary of Background Data. The Hart-ISSG PJFSS is a validated classification system for PJF. Reliability of the PJFSS has not been assessed. Methods. Sixteen detailed clinical scenarios were assessed using the ISSG PJFSS classification in six categories: neurologic status, axial pain, instrumentation issue, proximal kyphotic angle, level of upper instrumented vertebrae (UIV), and severity of UIV/UIV+1 fracture. Eleven spine surgeons evaluated each case in all six categories during two different assessments, and provided recommendations regarding operative revision or observation for each case. Inter- and intrarater reliability were calculated based on intraclass correlation coefficients. Results. All intraclass correlation coefficients demonstrated {"}almost perfect{"}' (0.817-0.988) inter-rater agreement for both assessments, except UIV/UIV+1 fracture severity during the second assessment, which demonstrated {"}substantial{"} agreement' (0.692). Five of six categories had {"}almost perfect{"} mean intrarater reliability (0.805-0.981), while {"}instrumentation issue{"} demonstrated {"}substantial{"} mean agreement (0.757). Inter-rater reliability for recommendation of surgical intervention was {"}almost perfect{"} during both assessments (0.911 and 0.922, respectively). Mean PJFSS scores between the two assessments were significantly higher for cases recommended for operative revision (8.43±0.90) versus cases recommended for observation (P<0.0001). Conclusion. The ISSG PJFSS is a reliable and repeatable classification system for assessing patients with PJF. Higher PJFSS scales correlate with recommendation for operative revision, extending prior external validation of the PJFSS.",

keywords = "Adult spinal deformity, Complications, Proximal junctional failure, Proximal junctional kyphosis, Validation",

author = "Hart, {Robert A.} and Farbod Rastegar and Alec Contag and Marie Kane and Alan Daniels and Eric Klineberg and Robert Eastlack and Smith, {Justin S.} and Richard Hostin and Hamilton, {D. Kojo} and Gum, {Jeffrey L.} and Burton, {Douglas C.} and Sheer, {Justin K.} and Christopher Ames and Frank Schwab and Virginie Lafage and Shay Bess and Christopher Shaffrey and Khaled Kebaish",

note = "Publisher Copyright: {\textcopyright} 2018 Wolters Kluwer Health, Inc.",

year = "2018",

month = apr,

day = "15",

doi = "10.1097/BRS.0000000000002498",

language = "English (US)",

volume = "43",

pages = "E461--E467",

journal = "Spine",

issn = "0362-2436",

publisher = "Lippincott Williams and Wilkins",

number = "8",

}

TY - JOUR

T1 - Inter-and intra-rater reliability of the hart-ISSG proximal junctional failure severity scale

AU - Hart, Robert A.

AU - Rastegar, Farbod

AU - Contag, Alec

AU - Kane, Marie

AU - Daniels, Alan

AU - Klineberg, Eric

AU - Eastlack, Robert

AU - Smith, Justin S.

AU - Hostin, Richard

AU - Hamilton, D. Kojo

AU - Gum, Jeffrey L.

AU - Burton, Douglas C.

AU - Sheer, Justin K.

AU - Ames, Christopher

AU - Schwab, Frank

AU - Lafage, Virginie

AU - Bess, Shay

AU - Shaffrey, Christopher

AU - Kebaish, Khaled

PY - 2018/4/15

Y1 - 2018/4/15

N2 - Study Design. Reliability/external validation study. Objective. Investigate inter- and intrarater reliability of the Hart-International Spine Study Group (ISSG) Proximal Junctional Failure Severity Scale (PJFSS) and its correlation with operative revision in patients with proximal junctional failure (PJF). Summary of Background Data. The Hart-ISSG PJFSS is a validated classification system for PJF. Reliability of the PJFSS has not been assessed. Methods. Sixteen detailed clinical scenarios were assessed using the ISSG PJFSS classification in six categories: neurologic status, axial pain, instrumentation issue, proximal kyphotic angle, level of upper instrumented vertebrae (UIV), and severity of UIV/UIV+1 fracture. Eleven spine surgeons evaluated each case in all six categories during two different assessments, and provided recommendations regarding operative revision or observation for each case. Inter- and intrarater reliability were calculated based on intraclass correlation coefficients. Results. All intraclass correlation coefficients demonstrated "almost perfect"' (0.817-0.988) inter-rater agreement for both assessments, except UIV/UIV+1 fracture severity during the second assessment, which demonstrated "substantial" agreement' (0.692). Five of six categories had "almost perfect" mean intrarater reliability (0.805-0.981), while "instrumentation issue" demonstrated "substantial" mean agreement (0.757). Inter-rater reliability for recommendation of surgical intervention was "almost perfect" during both assessments (0.911 and 0.922, respectively). Mean PJFSS scores between the two assessments were significantly higher for cases recommended for operative revision (8.43±0.90) versus cases recommended for observation (P<0.0001). Conclusion. The ISSG PJFSS is a reliable and repeatable classification system for assessing patients with PJF. Higher PJFSS scales correlate with recommendation for operative revision, extending prior external validation of the PJFSS.

AB - Study Design. Reliability/external validation study. Objective. Investigate inter- and intrarater reliability of the Hart-International Spine Study Group (ISSG) Proximal Junctional Failure Severity Scale (PJFSS) and its correlation with operative revision in patients with proximal junctional failure (PJF). Summary of Background Data. The Hart-ISSG PJFSS is a validated classification system for PJF. Reliability of the PJFSS has not been assessed. Methods. Sixteen detailed clinical scenarios were assessed using the ISSG PJFSS classification in six categories: neurologic status, axial pain, instrumentation issue, proximal kyphotic angle, level of upper instrumented vertebrae (UIV), and severity of UIV/UIV+1 fracture. Eleven spine surgeons evaluated each case in all six categories during two different assessments, and provided recommendations regarding operative revision or observation for each case. Inter- and intrarater reliability were calculated based on intraclass correlation coefficients. Results. All intraclass correlation coefficients demonstrated "almost perfect"' (0.817-0.988) inter-rater agreement for both assessments, except UIV/UIV+1 fracture severity during the second assessment, which demonstrated "substantial" agreement' (0.692). Five of six categories had "almost perfect" mean intrarater reliability (0.805-0.981), while "instrumentation issue" demonstrated "substantial" mean agreement (0.757). Inter-rater reliability for recommendation of surgical intervention was "almost perfect" during both assessments (0.911 and 0.922, respectively). Mean PJFSS scores between the two assessments were significantly higher for cases recommended for operative revision (8.43±0.90) versus cases recommended for observation (P<0.0001). Conclusion. The ISSG PJFSS is a reliable and repeatable classification system for assessing patients with PJF. Higher PJFSS scales correlate with recommendation for operative revision, extending prior external validation of the PJFSS.

KW - Adult spinal deformity

KW - Complications

KW - Proximal junctional failure

KW - Proximal junctional kyphosis

KW - Validation

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JO - Spine

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ER -

Inter-and intra-rater reliability of the hart-ISSG proximal junctional failure severity scale

Abstract

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