Clinical appearance and reliability in visual assessment after in situ fusion for high-grade isthmic spondylolisthesis
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Clinical appearance and reliability in visual assessment after in situ fusion for high‑grade isthmic spondylolisthesis Anders Joelson1 · Barbro I. Danielson2 · Rune Hedlund3 · Per Wretenberg1 · Karin Frennered3 Received: 6 June 2020 / Accepted: 8 September 2020 © Scoliosis Research Society 2020
Abstract Purpose The current literature on clinical appearance after surgery for high-grade spondylolisthesis is inconclusive. The few long-term comparative studies on surgical reduction versus in situ fusion report contradictory findings concerning appearance-related issues. The purpose of the current study was to evaluate and quantify clinical appearance three decades after in situ fusion for high-grade isthmic spondylolisthesis. Methods The Scoliosis Research Society (SRS)-22r questionnaire, digital photographs and standing lateral radiographs were used to evaluate clinical appearance for 22 patients three decades after in situ fusion for high-grade spondylolisthesis. The appearance was assessed by two spine surgeons, by the patient themselves, and by quantification of cosmesis relevant radiographic variables including pelvic parameters and sagittal balance. Results The surgeon inter- and intraobserver reliability of the photographic evaluation of the trunk deformity was at most moderate (Cohen’s kappa 0.5). Correlation analysis revealed at most medium correlation between radiographic outcome and self-rated (SRS-22r) self-image (Spearman’s rank correlation coefficient 0.3). The agreement between patient and surgeonrated trunk appearance was poor (Cohen’s kappa 0.2). Conclusions Photographic evaluation of the trunk deformity in high-grade spondylolisthesis is unreliable. There were only weak correlations between patient self-assessed trunk appearance and radiographic parameters. The results reflect the pronounced subjectivity of cosmesis, and that the trunk deformity in high-grade spondylolisthesis is not easily observed. Level of evidence IV. Keywords Cosmesis · Digital photographs · High-grade spondylolisthesis · In situ fusion · Reliability · Standing lateral radiographs · Visual assessment
Introduction
* Anders Joelson [email protected] 1
Department of Orthopaedics, Orebro University School of Medical Sciences, Orebro University Hospital, 701 85 Orebro, Sweden
2
Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
3
Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
The current literature on clinical appearance after surgery for high-grade spondylolisthesis is inconclusive. The few long-term comparative studies on surgical reduction versus in situ fusion report contradictory findings. For example, the comparative study of Burkus et al. [1] (reduction versus in situ fusion) found that no patient was dissatisfied with the cosmetic appearance or of persistence of
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