Interobserver and Intraobserver Agreement of Radiograph Interpretation With and Without Pedicle Screw Implants

Abstract

It is extremely difficult to interpret radiographic lumbar posterolateral fusion success. Such an assessment needs to be performed by use of a detailed radiographic classification system. The classification system presented here revealed good interobserver and intraobserver agreement, both with and without instrumentation. The classification showed acceptable reliability and may be one way to improve interstudy and intrastudy correlation of radiologic outcomes after posterolateral spinal fusion. Instrumentation did not influence reproducibility but may result in slightly underestimated fusion rates.

Clinical and radiological outcome of anterior–posterior fusion versus transforaminal lumbar interbody fusion for symptomatic disc degeneration: a retrospective comparative study of 133 patients

“…However, these studies included multiple diagnostic groups, and clinical as well as radiological outcomes were not always reported. Standard radiographs were used to assess fusion, which has been shown to underestimate pseudarthrosis rates [3,5,7].…”

Correlative radiological, self-assessment and clinical analysis of evolution in instrumented dorsal and lateral fusion for degenerative lumbar spine disease. Autograft versus coralline hydroxyapatite

“…Hardware makes assessment of bony fusion difficult with the use of plain roentgenograms only [15]. Because of these difficulties the authors of this study used oblique views, bending tests and CT scans that justified solid fusion in all patients and all fused segments.…”

“…However, in the presence of allografts and ceramics the interpretation of solid fusion seems to be difficult, particularly when hardware is added. In contrast, Christensen et al [15] compared non-instrumented lumbar fusion versus instrumented with Cotrel Dubousset (CD) instrumentation and reported similar interobserver and intraobserver agreement. In particular Christensen et al [15] reported in the CD group j values of 0.63 and 0.81 for interobserver and intraobserver agreement, respectively; while in the non-instrumented spines for the interobserver and intraobserver agreement the j values were 0.52 and 0.73, respectively.…”

“…In contrast, Christensen et al [15] compared non-instrumented lumbar fusion versus instrumented with Cotrel Dubousset (CD) instrumentation and reported similar interobserver and intraobserver agreement. In particular Christensen et al [15] reported in the CD group j values of 0.63 and 0.81 for interobserver and intraobserver agreement, respectively; while in the non-instrumented spines for the interobserver and intraobserver agreement the j values were 0.52 and 0.73, respectively. The authors in the present study used Christensen's system to evaluate fusion in instrumented lumbar spines and had an average intraobserver and interobserver coefficient, r, of 0.71 and 0.69, respectively.…”

“…The radiological evolution of the posterolateral fusion (CH resorption and bone formation) on the plain roentgenograms was evaluated by two independent senior orthopaedic radiologists who were considered as unbiased observers 3 months, 6 months, 12 months to 48 months postoperatively. There was a consensus between the radiologists on the definition of fusion according to Christiansen's classification [15]: grade 3=continuous intersegmental bony bridge; grade 2=doubtful fusion intersegmental bony bridge; grade 1=no intersegmental bony bridging fusion. As fusion (grade 3) was considered continuous bridging at all levels of instrumentation, at least at one plain roentgenogram associated with no pathologic movement in the bending roentgenograms.…”