• Renaud Lafage, Emmanuelle Ferrero, Jensen K Henry, Vincent Challier, Bassel Diebo, Barthelemy Liabaud, Virginie Lafage, and Frank Schwab.
• NYU Hospital for Joint Diseases; Department of Orthopaedic Surgery; New York; NY.
• Spine J. 2015 Sep 4.

Background ContextEvaluation of sagittal alignment is essential in the operative treatment of spine pathology, particularly adult spinal deformity (ASD). However, software applications for detailed spino-pelvic analysis are usually complex and not applicable to routine clinical use PURPOSE: To validate a new clinician-friendly software (Surgimap) in the setting of ASD.Study Design/SettingAccuracy and inter- and intra-rater reliability of a spine measurement software. Five users (2 experienced -spine surgeon, 3 novice - spine researched fellow) independently performed each part of the study in two rounds with one week between measurements.Patient Sample50 ASD patients drawn from a prospective database.Outcome MeasuresSpinal, pelvic, and cervical measurements parameters (including pelvic tilt [PT], pelvic incidence [PI], lumbar-pelvic mismatch [PI-LL], lumbar lordosis [LL], thoracic kyphosis [TK], T1 spino-pelvic inclination [T1SPI], sagittal vertical axis [SVA], cervical lordosis [CL]).MethodsFor the accuracy evaluation, 30 ASD patient radiographs were pre-marked for anatomic landmarks. Each radiograph was measured twice with the new software (Surgimap); measurements were compared to those from a previously validated software. For the reliability and reproducibility evaluation, users measured 50 unmarked ASD radiographs in two rounds. Intra-class correlation (ICC) and International Standardization Organization (ISO) reproducibility values were calculated. Measurement time was recorded.ResultsSurgimap demonstrated excellent accuracy as assessed by the mean absolute difference from validated measurements: PT 0.12°, PI 0.35°, LL 0.58°, PI-LL 0.46°, TK 5.25°, T1SPI 0.53°, SVA 2.04mm. The inter- and intra-observer reliability analysis revealed good to excellent agreement for all parameters. The mean difference between rounds was <0.4° for PT, PI, LL, PI-LL, and T1SPI and <0.3mm for SVA. For PT, PI, LL, PI-LL, TK, T1SPI, and SVA, the intra-observer ICC values were all >0.93 and the inter-observer ICC were all >0.87. Parameters based on point landmarks rather than endplate orientation had a better reliability (ICC≥0.95 vs. ICC≥0.84). The average time needed to perform a full spino-pelvic analysis with Surgimap was 75 seconds (+25).ConclusionsUsing this new software tool, a simple method for full spine analysis can be performed quickly, accurately, and reliably. The proposed list of parameters offers quantitative values of the spine and pelvis, setting the stage for proper pre-operative planning. The new software tool provides an important bridge between clinical and research needs.Copyright © 2015. Published by Elsevier Inc.

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