Variability in Assessing Spinopelvic Parameters with Lumbosacral Transitional Vertebrae

Amrit S. Khalsa, Gregory M. Mundis, Mitsuru Yagi, Richard G. Fessler, Shay Bess, Naobumi Hosogane, Paul Park, Khoi Than, Alan Daniels, Justin Iorio, Justin B. Ledesma, Stacie Tran, Robert K. Eastlack

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Study Design. Prospectively collected survey study Objective. The aim of this study was to determine the consistency with which spinopelvic parameters (SPP) are determined in patients with lumbosacral transitional vertebrae (LSTV). Summary of Background Data. The incidence of LSTV in the general population is as high as 35.6%. The often fixed nature of LSTV relative to the pelvis, but lumbar-type appearance, may lead to differential use of the S1 endplate when performing SPP assessment. This could have significant impact on SPP derived from these landmarks, resulting in considerable variation in surgical planning and decision-making. Methods. Twenty patients demonstrating LSTV on standing lateral 36-inch spinal radiographs were randomly arranged and independently analyzed by 16 experienced spine surgeons using the same computer software. Pelvic incidence (PI), pelvic tilt (PT), lumbar lordosis (LL), and T1 pelvic angle (TPA) were captured. Two weeks after the first assessment, surgeons repeated the measurements after image sequence re-randomization. Intraclass correlation coefficient (ICC) was calculated to evaluate interobserver reliability (IOR) for each SPP. Intraobserver reliability (IAOR) was assessed through an average Pearson correlation coefficient for each parameter for each surgeon. Results. Sixteen surgeons completed initial measurements. IOR was poor for TPA (0.35, 95% confidence interval [CI] 0.20, 0.58) and PI (0.42, 95% CI 0.26, 0.65) and fair for LL (0.67, 95% CI 0.51, 0.82), and PT (0.63, 95% CI 0.47, 0.81). Fourteen surgeons completed phase-2 measurements to assess IAOR. Average parameter PPC showed excellent IAOR (LL 0.86, TPA 0.77, PI 0.78, PT 0.86). Kappa coefficient showed fair agreement for raters choosing the same endplate for measurement (Phase 1: 0.38, Phase 2: 0.32). By patient, the percentage of raters that chose the S1 endplate for measurement varied from 6.3% to 85.7%. Conclusion. Significant variability exists when surgeons measure SPP in patients with LSTV. These parameters are critical in determining the goals of surgical reconstruction and such variability may have considerable implications for radiographic goals and outcomes of surgical reconstruction.

Original languageEnglish (US)
Pages (from-to)813-816
Number of pages4
JournalSpine
Volume43
Issue number12
DOIs
StatePublished - Jun 15 2018

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Spine
Lordosis
Confidence Intervals
Incidence
Random Allocation
Pelvis
Surgeons
Decision Making
Software
Population

Keywords

  • lumbarized S1
  • lumbosacral transitional vertebrae
  • sacralized L5
  • transitional anatomy

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Khalsa, A. S., Mundis, G. M., Yagi, M., Fessler, R. G., Bess, S., Hosogane, N., ... Eastlack, R. K. (2018). Variability in Assessing Spinopelvic Parameters with Lumbosacral Transitional Vertebrae. Spine, 43(12), 813-816. https://doi.org/10.1097/BRS.0000000000002433

Variability in Assessing Spinopelvic Parameters with Lumbosacral Transitional Vertebrae. / Khalsa, Amrit S.; Mundis, Gregory M.; Yagi, Mitsuru; Fessler, Richard G.; Bess, Shay; Hosogane, Naobumi; Park, Paul; Than, Khoi; Daniels, Alan; Iorio, Justin; Ledesma, Justin B.; Tran, Stacie; Eastlack, Robert K.

In: Spine, Vol. 43, No. 12, 15.06.2018, p. 813-816.

Research output: Contribution to journalArticle

Khalsa, AS, Mundis, GM, Yagi, M, Fessler, RG, Bess, S, Hosogane, N, Park, P, Than, K, Daniels, A, Iorio, J, Ledesma, JB, Tran, S & Eastlack, RK 2018, 'Variability in Assessing Spinopelvic Parameters with Lumbosacral Transitional Vertebrae', Spine, vol. 43, no. 12, pp. 813-816. https://doi.org/10.1097/BRS.0000000000002433
Khalsa AS, Mundis GM, Yagi M, Fessler RG, Bess S, Hosogane N et al. Variability in Assessing Spinopelvic Parameters with Lumbosacral Transitional Vertebrae. Spine. 2018 Jun 15;43(12):813-816. https://doi.org/10.1097/BRS.0000000000002433
Khalsa, Amrit S. ; Mundis, Gregory M. ; Yagi, Mitsuru ; Fessler, Richard G. ; Bess, Shay ; Hosogane, Naobumi ; Park, Paul ; Than, Khoi ; Daniels, Alan ; Iorio, Justin ; Ledesma, Justin B. ; Tran, Stacie ; Eastlack, Robert K. / Variability in Assessing Spinopelvic Parameters with Lumbosacral Transitional Vertebrae. In: Spine. 2018 ; Vol. 43, No. 12. pp. 813-816.
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abstract = "Study Design. Prospectively collected survey study Objective. The aim of this study was to determine the consistency with which spinopelvic parameters (SPP) are determined in patients with lumbosacral transitional vertebrae (LSTV). Summary of Background Data. The incidence of LSTV in the general population is as high as 35.6{\%}. The often fixed nature of LSTV relative to the pelvis, but lumbar-type appearance, may lead to differential use of the S1 endplate when performing SPP assessment. This could have significant impact on SPP derived from these landmarks, resulting in considerable variation in surgical planning and decision-making. Methods. Twenty patients demonstrating LSTV on standing lateral 36-inch spinal radiographs were randomly arranged and independently analyzed by 16 experienced spine surgeons using the same computer software. Pelvic incidence (PI), pelvic tilt (PT), lumbar lordosis (LL), and T1 pelvic angle (TPA) were captured. Two weeks after the first assessment, surgeons repeated the measurements after image sequence re-randomization. Intraclass correlation coefficient (ICC) was calculated to evaluate interobserver reliability (IOR) for each SPP. Intraobserver reliability (IAOR) was assessed through an average Pearson correlation coefficient for each parameter for each surgeon. Results. Sixteen surgeons completed initial measurements. IOR was poor for TPA (0.35, 95{\%} confidence interval [CI] 0.20, 0.58) and PI (0.42, 95{\%} CI 0.26, 0.65) and fair for LL (0.67, 95{\%} CI 0.51, 0.82), and PT (0.63, 95{\%} CI 0.47, 0.81). Fourteen surgeons completed phase-2 measurements to assess IAOR. Average parameter PPC showed excellent IAOR (LL 0.86, TPA 0.77, PI 0.78, PT 0.86). Kappa coefficient showed fair agreement for raters choosing the same endplate for measurement (Phase 1: 0.38, Phase 2: 0.32). By patient, the percentage of raters that chose the S1 endplate for measurement varied from 6.3{\%} to 85.7{\%}. Conclusion. Significant variability exists when surgeons measure SPP in patients with LSTV. These parameters are critical in determining the goals of surgical reconstruction and such variability may have considerable implications for radiographic goals and outcomes of surgical reconstruction.",
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AU - Khalsa, Amrit S.

AU - Mundis, Gregory M.

AU - Yagi, Mitsuru

AU - Fessler, Richard G.

AU - Bess, Shay

AU - Hosogane, Naobumi

AU - Park, Paul

AU - Than, Khoi

AU - Daniels, Alan

AU - Iorio, Justin

AU - Ledesma, Justin B.

AU - Tran, Stacie

AU - Eastlack, Robert K.

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N2 - Study Design. Prospectively collected survey study Objective. The aim of this study was to determine the consistency with which spinopelvic parameters (SPP) are determined in patients with lumbosacral transitional vertebrae (LSTV). Summary of Background Data. The incidence of LSTV in the general population is as high as 35.6%. The often fixed nature of LSTV relative to the pelvis, but lumbar-type appearance, may lead to differential use of the S1 endplate when performing SPP assessment. This could have significant impact on SPP derived from these landmarks, resulting in considerable variation in surgical planning and decision-making. Methods. Twenty patients demonstrating LSTV on standing lateral 36-inch spinal radiographs were randomly arranged and independently analyzed by 16 experienced spine surgeons using the same computer software. Pelvic incidence (PI), pelvic tilt (PT), lumbar lordosis (LL), and T1 pelvic angle (TPA) were captured. Two weeks after the first assessment, surgeons repeated the measurements after image sequence re-randomization. Intraclass correlation coefficient (ICC) was calculated to evaluate interobserver reliability (IOR) for each SPP. Intraobserver reliability (IAOR) was assessed through an average Pearson correlation coefficient for each parameter for each surgeon. Results. Sixteen surgeons completed initial measurements. IOR was poor for TPA (0.35, 95% confidence interval [CI] 0.20, 0.58) and PI (0.42, 95% CI 0.26, 0.65) and fair for LL (0.67, 95% CI 0.51, 0.82), and PT (0.63, 95% CI 0.47, 0.81). Fourteen surgeons completed phase-2 measurements to assess IAOR. Average parameter PPC showed excellent IAOR (LL 0.86, TPA 0.77, PI 0.78, PT 0.86). Kappa coefficient showed fair agreement for raters choosing the same endplate for measurement (Phase 1: 0.38, Phase 2: 0.32). By patient, the percentage of raters that chose the S1 endplate for measurement varied from 6.3% to 85.7%. Conclusion. Significant variability exists when surgeons measure SPP in patients with LSTV. These parameters are critical in determining the goals of surgical reconstruction and such variability may have considerable implications for radiographic goals and outcomes of surgical reconstruction.

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KW - lumbarized S1

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KW - sacralized L5

KW - transitional anatomy

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