A new classification for coronal malalignment in adult spinal deformity: a validation and the role of lateral bending radiographs

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...

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Published in:	European spine journal Vol. 29; no. 9; pp. 2287 - 2294
Main Authors:	Hayashi, Kazunori, Boissière, Louis, Cawley, Derek T., Larrieu, Daniel, Kieser, David, Berjano, Pedro, Lamartina, Claudio, Gupta, Munich, Silvestre, Clément, Protopsaltis, Themi, Bourghli, Anouar, Pellisé, Ferran, Annis, Prokopis, Papadopoulos, Elias C., Kreichati, Gaby, Pizones, Javier, Nakamura, Hiroaki, Ames, Christopher P., Obeid, Ibrahim
Format:	Journal Article
Language:	English
Published:	Berlin/Heidelberg Springer Berlin Heidelberg 01-09-2020 Springer Nature B.V
Subjects:	Classification Decision making Medicine Medicine & Public Health Neurosurgery Original Article Radiography Surgeons Surgical Orthopedics Adult spinal deformity Malalignment Coronal Classification Validation study
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Summary:	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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0940-6719 1432-0932
DOI:	10.1007/s00586-020-06513-5