• Kazunori Hayashi, Louis Boissière, Derek T Cawley, Daniel Larrieu, David Kieser, Pedro Berjano, Claudio Lamartina, Munich Gupta, Clément Silvestre, Themi Protopsaltis, Anouar Bourghli, Ferran Pellisé, Prokopis Annis, Elias C Papadopoulos, Gaby Kreichati, Javier Pizones, Hiroaki Nakamura, Christopher P Ames, and Ibrahim Obeid.
• Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Place Amélie Raba-Léon, 33076, Bordeaux, France. kh_ocg@yahoo.co.jp.
• Eur Spine J. 2020 Sep 1; 29 (9): 2287-2294.

PurposeCoronal 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.MethodsFifteen 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.ResultsIntra-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.ConclusionsAdequate 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.

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