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Intraobserver and Interobserver Reliability of the Classification of Thoracic Adolescent Idiopathic Scoliosis*†

LENKE, LAWRENCE G., M.D.‡; BETZ, RANDAL R., M.D.§; BRIDWELL, KEITH H., M.D.‡; CLEMENTS, DAVID H., M.D.#; HARMS, JÜRGEN, M.D.**; LOWE, THOMAS G., M.D.††; SHUFFLEBARGER, HARRY L., M.D.‡‡, ST. LOUIS MISSOURI

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The system described by King et al. is the standard method for the classification of thoracic adolescent idiopathic scoliosis. Although it is widely used and referenced, its reliability and reproducibility among scoliosis surgeons are unknown. We used a scoliosis case-presentation format to examine the interobserver and intraobserver reliability of the classification of thoracic adolescent idiopathic scoliosis with the system of King et al. Eight active, current members of the Scoliosis Research Society reviewed twenty-seven full-length radiographs that had been made before operative correction of the scoliotic deformity. On the basis of these images, which included posteroanterior and lateral radiographs made with the patient standing as well as right and left forced-side-bending radiographs made with the patient supine, the reviewers assigned a type to each curve according to the classification system of King et al. Kappa coefficients were used to test statistical reliability.The mean interobserver reliability of the classification was only 64 per cent (range, 54 to 77 per cent) when the responses of seven of the reviewers were compared with those of one of the originators of the classification. The mean kappa coefficient was 0.49 (range, 0.27 to 0.73), which indicates poor reliability. When each reviewer's responses were compared with those of the other reviewers, the reliability was similarly poor (interobserver reliability, 55 per cent [range, 33 to 81 per cent] and mean kappa coefficient, 0.40 [range, 0.21 to 0.63]). Intraobserver reliability was evaluated in a trial in which five reviewers in a group setting were shown the same radiographs in a different order at two different viewings. Comparison of the results at the two viewings revealed a mean intraobserver reliability of 69 per cent (range, 56 to 85 per cent) and a mean kappa coefficient of 0.62 (range, 0.34 to 0.95), which indicates fair reliability.The current method of classification of adolescent idiopathic scoliosis does not appear to have sufficient intraobserver or interobserver reliability among scoliosis surgeons to portray curve types accurately. Thus, it may not help to guide treatment with use of modern spinal fixation methods.

†Read at the Annual Meeting of the Scoliosis Research Society, Ottawa, Canada, September 26, 1996.

‡Department of Orthopaedic Surgery, Spinal Deformity Service, Washington University, One Barnes Plaza, Suite 11300, St. Louis, Missouri 63110. E-mail address for Dr. Lenke: lenkel@msnotes.wustl.edu. Please address requests for reprints to Dr. Lenke.

§Shriners Hospital, 8400 Roosevelt Boulevard, Philadelphia, Pennsylvania 19152.

#Temple University Hospital, 3401 North Broad Street, Philadelphia, Pennsylvania 19140.

**Rehabilitations Krankenhaus, Guttmannwtr.1, Postfach 327, 7516 Karlsbad, Langensteinbach, Germany.

††3550 Lutheran Parkway, Suite 201, Wheat Ridge, Colorado 80033.

‡‡1150 Campo Sano Avenue, Suite 300, Coral Gables, Florida 33146.

Copyright © 1998 by The Journal of Bone and Joint Surgery, Incorporated
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