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Spine Deform. 2018 Jul - Aug;6(4):358-365. doi: 10.1016/j.jspd.2017.12.001.

Radiographic Classification for Degenerative Spondylolisthesis of the Lumbar Spine Based on Sagittal Balance: A Reliability Study.

Author information

1
Department of Spinal Surgery Unit 1, Université de Bordeaux, Bordeaux University Hospital, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076 Bordeaux, France. Electronic address: soufiane.ghailane@gmail.com.
2
Department of Spinal Surgery Unit 1, Université de Bordeaux, Bordeaux University Hospital, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076 Bordeaux, France.
3
University of Exeter, School of Physics and Astronomy, Exeter, United Kingdom.

Abstract

STUDY DESIGN:

Inter- and intraobserver reliability study.

OBJECT:

To assess the reliability of a new radiographic classification of degenerative spondylolisthesis of the lumbar spine (DSLS).

SUMMARY OF BACKGROUND DATA:

DSLS is a common cause of chronic low back and leg pain in adults. To this date, there is no consensus for a comprehensive analysis of DSLS. The reliability of a new DSLS classification system based on sagittal alignment was assessed.

METHODS:

Ninety-nine patients admitted to our spinal surgery department for surgical treatment of DSLS between January 2012 and December 2015 were included. Three observers measured sagittal alignment parameters with validated software: segmental lordosis (SL), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sagittal vertical axis (SVA). Full body low-dose lateral view radiographs were analyzed and classified according to three main types: Type 1A: preserved LL and SL; Type 1B: preserved LL and reduced SL (≤5°); Type 2A: PI-LL ≥10° without pelvic compensation (PT <25°); Type 2B: PI-LL ≥10° with pelvic compensation (PT ≥25°); Type 3: global sagittal malalignment (SVA ≥40 mm). The three observers classified radiographs twice with a 3-week interval for intraobserver reproducibility. Interobserver reproducibility was calculated using Fleiss κ and intra-class coefficient. Intraobserver reproducibility was calculated using Cohen κ.

RESULTS:

Mean age was 68.8 ± 9.8 years. Mean sagittal alignment parameters values were the following: PI: 60.1° ± 12.7°; PI-LL was 12.2° ± 13.9°, PT: 24.7° ± 8.5°; SVA: 44.9 mm ± 44.6 mm; SL: 16.6° ± 8.4°. Intraobserver repeatability showed an almost perfect agreement (ICC > 0.92 and Cohen κ > 0.89 for each observer). Fleiss κ value for interobserver reproducibility was 0.82, with percentage agreement among observers between 88% and 89%.

CONCLUSION:

This new classification showed an excellent inter- and intraobserver reliability. This simple method could be an additional sagittal balance tool helping surgeons improve their preoperative DSLS analysis.

KEYWORDS:

Classification system; Degenerative spondylolisthesis; Lumbar spine; Spondylolisthesis

PMID:
29886905
DOI:
10.1016/j.jspd.2017.12.001
[Indexed for MEDLINE]

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