A Noelle Larson1, Charles Gerald T Ledonio2, Ann M Brearley2, Daniel J Sucato3, Leah Y Carreon4, Alvin H Crawford5, David A Stevenson6, Michael G Vitale7, Christopher L Moertel2, David W Polly8. 1. Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA. 2. Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN 55455, USA. 3. Texas Scottish Rite Hospital, 2222 Welborn St., Dallas, TX 75219, USA. 4. Norton Leatherman Spine Center, 210 E. Gray St., Suite 900, Louisville, KY 40202, USA. 5. Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229, USA. 6. Division of Medical Genetics, University of Utah, 201 Presidents Cir., Salt Lake City, UT 84112, USA; Division of Medical Genetics, Stanford University, 450 Serra Mall, Stanford, CA 94305, USA. 7. Department of Orthopedic Surgery, Columbia University Medical Center, 630 W 168th St., New York, NY 10032, USA. 8. Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN 55455, USA. Electronic address: pollydw@umn.edu.
Abstract
BACKGROUND: Scoliosis in patients with neurofibromatosis type I (NF1) can manifest as dystrophic or nondystrophic curves. Dystrophic scoliosis is rapidly progressive, rendering treatment challenging. Radiographic characteristics have been reported to predict dystrophic scoliosis, but their reliability and predictive value have not been well described. The purpose of this study is to assess the interobserver reliability for eight radiographic characteristics of dystrophic scoliosis and to evaluate the sensitivity and specificity of these characteristics relative to the gold standard of a definitive clinical diagnosis. METHODS: Spine radiographs of 122 NF1 patients from multiple institutions were graded by five spine surgeons as dystrophic or nondystrophic, based on eight radiographic characteristics of dystrophic modulation: rib penciling, vertebral rotation, scalloping, wedging, spindling of transverse processes, short sharp angular curve, widened interpedicular distance, and atypical location. The curves were classified by each submitting institution as dystrophic or nondystrophic based on clinical outcome. Interobserver reliability analysis was performed using Fleiss kappa. RESULTS: For the 122 cases, the interrater agreement among the five readers for the diagnosis of dystrophic scoliosis was good at 0.61. The agreement for individual radiographic characteristic ranged from 0.62 for wedging to 0.14 (poor) for scalloping. Surgeons underestimated the number of dystrophic curves, rating from 45% to 67% of the curve patterns as dystrophic, compared to the gold standard, which revealed 68% of the curves to be dystrophic. On multivariate analysis, rib penciling, vertebral rotation, vertebral wedging, and atypical location were significantly associated with true dystrophic status (odds ratios of 2.4, 3.0, 2.4, and 3.0, respectively). CONCLUSION: Overall dystrophic diagnosis can be assessed by radiographic characteristics. Better understanding of the predictive value of specific radiographic features may assist in early diagnosis of patients with dystrophic NF and assist surgeons in identifying dystrophic curve patterns and instituting prompt, appropriate treatment. LEVEL OF EVIDENCE: Level III.
BACKGROUND:Scoliosis in patients with neurofibromatosis type I (NF1) can manifest as dystrophic or nondystrophic curves. Dystrophic scoliosis is rapidly progressive, rendering treatment challenging. Radiographic characteristics have been reported to predict dystrophic scoliosis, but their reliability and predictive value have not been well described. The purpose of this study is to assess the interobserver reliability for eight radiographic characteristics of dystrophic scoliosis and to evaluate the sensitivity and specificity of these characteristics relative to the gold standard of a definitive clinical diagnosis. METHODS: Spine radiographs of 122 NF1patients from multiple institutions were graded by five spine surgeons as dystrophic or nondystrophic, based on eight radiographic characteristics of dystrophic modulation: rib penciling, vertebral rotation, scalloping, wedging, spindling of transverse processes, short sharp angular curve, widened interpedicular distance, and atypical location. The curves were classified by each submitting institution as dystrophic or nondystrophic based on clinical outcome. Interobserver reliability analysis was performed using Fleiss kappa. RESULTS: For the 122 cases, the interrater agreement among the five readers for the diagnosis of dystrophic scoliosis was good at 0.61. The agreement for individual radiographic characteristic ranged from 0.62 for wedging to 0.14 (poor) for scalloping. Surgeons underestimated the number of dystrophic curves, rating from 45% to 67% of the curve patterns as dystrophic, compared to the gold standard, which revealed 68% of the curves to be dystrophic. On multivariate analysis, rib penciling, vertebral rotation, vertebral wedging, and atypical location were significantly associated with true dystrophic status (odds ratios of 2.4, 3.0, 2.4, and 3.0, respectively). CONCLUSION: Overall dystrophic diagnosis can be assessed by radiographic characteristics. Better understanding of the predictive value of specific radiographic features may assist in early diagnosis of patients with dystrophic NF and assist surgeons in identifying dystrophic curve patterns and instituting prompt, appropriate treatment. LEVEL OF EVIDENCE: Level III.
Authors: Rosa Nguyen; Eva Dombi; Srivandana Akshintala; Andrea Baldwin; Brigitte C Widemann Journal: J Neurooncol Date: 2014-10-08 Impact factor: 4.130
Authors: Marios G Lykissas; Elizabeth K Schorry; Alvin H Crawford; Sean Gaines; Margaret Rieley; Viral V Jain Journal: Spine (Phila Pa 1976) Date: 2013-08-15 Impact factor: 3.468