• Rui-Qiang Chen, Naobumi Hosogane, Kota Watanabe, Haruki Funao, Eijiro Okada, Nobuyuki Fujita, Tomohiro Hikata, Akio Iwanami, Takashi Tsuji, Ken Ishii, Takayuki Abe, Yoshiaki Toyama, Masaya Nakamura, and Morio Matsumoto.
• *Department of Orthopedic Surgery, Keio University, Tokyo, Japan †Department of Spine Surgery, The 3rd Affiliated Hospital of Sun Yat-sen University, Guangzhou, China ‡Department of Orthopedic Surgery, National Defense Medical College, Saitama, Japan §Department of Advanced Therapy for Spine and Spinal Cord Disorders, Keio University, Tokyo, Japan ||Kawasaki Municipal Hospital, Kanagawa Japan ¶Saiseikai Central Hospital, Tokyo, Japan #Kitasato Institute Hospital, Tokyo, Japan **Department of Preventive Medicine and Public Health, Center for Clinical Research, Keio University School of Medicine, Tokyo, Japan.
• Spine. 2015 Sep 11.

Study DesignRetrospective study.ObjectiveTo examine the reliabilities of sagittal spino-pelvic alignment measurements using whole spine-pelvic and local pelvic radiographs, and to determine whether spinal deformity affects these reliabilities.Summary Of Background DataSagittal spino-pelvic alignment is important in adult spinal deformity patients (ASD). Spino-pelvic parameters are closely related to health-related quality of life and indispensable for surgical planning. However, few studies have focused on the reliability of these measurements.MethodsThree spino-pelvic parameters, pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS), were measured in two patient groups: 33 adult scoliosis (AS) and 33 non-deformity (ND) patients, using whole spine-pelvic lateral radiographs (whole spine radiographs) and local pelvic lateral radiographs (local pelvic radiographs), by 5 experienced spine surgeons. Intra- and inter-observer reliabilities for each procedure were evaluated by intra-class correlation coefficients (ICC). The inter-observer reliability differences between the two procedures were statistically evaluated. The difference between the largest and smallest measurements among the 5 observers was also evaluated in the AS and ND groups.ResultsMeasurement of the 3 parameters using whole spine or local pelvic radiographs showed good to excellent intra-observer reliability (range of ICC: 0.820 to 0.935). The inter-observer reliabilities of PI and PT from local pelvic radiographs were significantly higher than those from whole spine radiographs (p < 0.002). The intra-observer reliabilities of PI and PT from pelvic radiographs tended to be higher than those from whole spine radiographs, but the differences were not statistically significant. The reliability of SS was comparable between the two methods. The differences between the highest and lowest PI and PT measurements were smaller with the pelvic compared to whole spine radiographs. These findings were consistent in the AS and ND groups.ConclusionLocal pelvic radiography is more reliable than whole spine radiography for determining spino-pelvic parameters, and we recommend its use for evaluating ASD patients.Level Of Evidence3.

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