• Munish Gupta, Jensen K Henry, Frank Schwab, Eric Klineberg, Justin S Smith, Jeffrey Gum, David W Polly, Barthelemy Liabaud, Bassel G Diebo, D Kojo Hamilton, Robert Eastlack, Peter G Passias, Douglas Burton, Themistocles Protopsaltis, Virginie Lafage, and International Spine Study Group.
• *Department of Orthopaedic Surgery, University of California, Davis, CA†Department of Orthopaedic Surgery, Spine Division, NYU Hospital for Joint Diseases, New York, NY‡Department of Neurosurgery, University of Virginia, Charlottesville, Virginia§Norton Leatherman Spine Center, Louisville, KY||Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN¶Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA#Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA**Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS.
• Spine. 2016 Jan 1; 41 (1): E22-7.

Study DesignMeasurement reliability study of adult spinal deformity (ASD) patient radiographs using intraclass correlation coefficients (ICC) and variance.ObjectiveThe aim of the study was to compare picture archiving and communication systems (PACS) to dedicated spine measurement software (SMS).Summary Of Background DataAccurate radiographic measurement of sagittal alignment is essential for evaluating ASD. PACS measurements often necessitate rudimentary techniques and estimations of anatomic landmarks and angles. Though SMS has been studied and validated, no studies directly compare PACS to SMS.MethodsEleven independent observers (7 spine surgeons, 4 researchers) digitally measured 20 ASD radiographs for pelvic incidence (PI), pelvic tilt (PT), lumbar lordosis (LL), PI-LL, thoracic kyphosis (TK), and sagittal vertical axis (SVA). Round 1 used PACS basic line/angle tools; Round 2 used a validated SMS that automatically calculates spino-pelvic parameters from 6 user-identified landmarks. Means, coefficient of variance (CV), and intraclass correlation coefficients (ICC) were analyzed.ResultsPACS measurements were significantly greater than SMS (PI, PT, PI-LL: P < 0.0001), though within clinical and measurement margins of error. Excluding TK, the variations in measurement (CV) were significantly greater for PACS (14-34%) vs. SMS (11-23%). Reliability was greater in SMS than PACS for PI, PT, PI-LL, LL, and SVA. The greatest differences in intraclass correlation coefficients (ICC) between PACS and SMS were in PI (PACS: 0.647; SMS: 0.810) and PI-LL (PACS: 0.921; SMS: 0.970). Among surgeons, the differences between PACS and SMS were augmented, and SMS had higher intraclass correlation coefficients (ICC) than PACS for all parameters (mean intraclass correlation coefficients [ICC] 0.931 vs. 0.861). Among surgeons, PI had the lowest reliability (Pacs0.505; SMS: 0.752) and SVA had the highest (Pacs0.985; SMS: 0.994).ConclusionSMS provides significantly more reliable measurements than PACS, especially among surgeons. Consistent use of SMS in the evaluation and surgical planning of ASD patients appears necessary given the significant differences in values, variance, and reliability between PACS and SMS.

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