title: Reliability of cervical lordosis and global sagittal spinal balance measurements in adolescent idiopathic scoliosis.
abstract: METHODS
  Radiological reproducibility study.
  
  
  OBJECTIVE
  To assess intra and interobserver reliability of radiographic measurements for global sagittal balance parameters and sagittal spine curves, including cervical spine. Sagittal spine balance in adolescent idiopathic scoliosis (AIS) is a main issue and many studies have been reported, showing that coronal and sagittal deformities often involve sagittal cervical unbalance. Global sagittal balance aims to obtain a horizontal gaze and gravity line at top of hips when subject is in a static position, involving adjustment of each spine curvature in the sagittal plane. To our knowledge, no study did use a methodologically validated imaging analysis tool able to appreciate sagittal spine contours and distances in AIS and especially in the cervical region.
  
  
  METHODS
  Lateral full-spine low-dose EOS radiographs were performed in 75 patients divided in three groups (control subjects, AIS, operated AIS). Three observers digitally analyzed twice each radiograph and 11 sagittal measures were collected for each image. Reliability was assessed calculating intraobserver Pearson's r correlation coefficient, interobserver intra-class correlation coefficient (ICC) completed with a two-by-two Bland-Altman plot analysis.
  
  
  RESULTS
  This measurement method has shown excellent intra and interobserver reliability in all parameters, sagittal curvatures, pelvic parameters and global sagittal balance.
  
  
  CONCLUSIONS
  This study validated a simple and efficient tool in AIS sagittal contour analysis. It defined new relevant landmarks allowing to characterize cervical segmental curvatures and cervical involvement in global balance.
authors.affiliation: Department of Pediatric Orthopaedics, Robert Debré Hospital, Paris 7 University, AP-HP, 48 Boulevard Sérurier, 75019, Paris, France. cvidalm2@yahoo.fr
authors.forename: Christophe
authors.initials: C
authors.lastname: Vidal
authors.forename: Brice
authors.initials: B
authors.lastname: Ilharreborde
authors.forename: Robin
authors.initials: R
authors.lastname: Azoulay
authors.forename: Guy
authors.initials: G
authors.lastname: Sebag
authors.forename: Keyvan
authors.initials: K
authors.lastname: Mazda
mesh_terms: D000293:Adolescent; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging*; D002648:Child; D005260:Female; D006801:Humans; D008141:Lordosis / Q000000981:diagnostic imaging*; D008297:Male; D011859:Radiography; D015203:Reproducibility of Results; D012600:Scoliosis / Q000000981:diagnostic imaging*; D013131:Spine / Q000000981:diagnostic imaging
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