Inter-Rater Reliability of Partially Automated Segmentation of Spinal Radiographs in Adult Spinal Deformity Patients.

Abstract

Spinopelvic radiographic measurements are fundamental in the evaluation and treatment of adult spinal deformity (ASD). Measuring spinopelvic parameters has become quicker and more reliable with the development of automated softwares, such as the Knowledge Environment for Orthopedic Personalized Surgery (KEOPS), but reliability in clinical practice may be limited by variable image quality. The aim of this study is to determine the inter-rater reliability of partially automated measurement of spinopelvic parameters for ASD patients using the KEOPS software. Representative preoperative and postoperative full-length spinal radiographs of five patients who underwent surgical correction of ASD were selected from an imaging database. Five fellowship-trained spine surgeons, one spine fellow, and one orthopedic surgery resident performed manual segmentation on each image, followed by automated measurement of spinopelvic parameters by the KEOPS software. Inter-rater reliabilty was evaluated using intraclass correlation coefficients (ICCs) and 95% condifence intervals (CIs). The proportion of images for which segmentation was successfully completed by the KEOPS software was analyzed. The ICCs indicated excellent inter-rater reliability for all spinopelvic parameters. The highest ICC was observed for pelvic tilt (0.994, 95% CI: 0.985-0.998), and the lowest for C2-C7 lordosis (0.954, 95% CI: 0.851-0.995). Segmentation completion rates decreased in the cervical spine, ranging from 88-97% in the sagittal plane and 51-61% in the coronal plane due to poor visualization. The partially automated system using KEOPS demonstrates excellent inter-rater reliability for calculating spinopelvic parameters in ASD patients. Segmentation involving the cervical spine remains less consistent on both sagittal and coronal radiographs.