title: The Interobserver and Intraobserver Reliability of the Sanders Classification Versus the Risser Stage.
abstract: BACKGROUND
  Estimation of skeletal maturity, classically performed using Risser sign, plays a crucial role in the treatment of AIS. Recent data, however, has shown the simplified Tanner-Whitehouse (Sanders) classification, based on an anteriorposterior (AP) hand radiographs, to correlate more closely to the rapid growth phase and thus curve progression. This study evaluated the interobserver and intraobserver reliability of the Sanders and Risser classifications among clinicians at different levels of training.
  
  
  METHODS
  Twenty AP scoliosis radiographs and 20 AP hand radiographs were randomized and distributed to 11 graders. The graders consisted of 3 orthopaedic residents, 3 spine fellows, 3 spine surgeons, and 1 radiologist. The graders were then asked to classify the radiographs according to the Sanders and Risser classifications. There were 3 rounds of grading, each done 3 weeks apart. The overall κ coefficient was then calculated for each system to evaluate the interobserver and intraobserver reliability.
  
  
  RESULTS
  For all graders the average κ coefficient for the interobserver and intraobserver reliability of the Sanders classification was 0.54 and 0.62, respectively, and 0.46 and 0.49 for the Risser classification. With respect to spine attendings alone, the average κ coefficient for the interobserver and intraobserver reliability of Sanders classification was 0.72 and 0.77, respectively, and 0.46 and 0.67 for the Risser classification.
  
  
  CONCLUSIONS
  Our study demonstrated that the Sanders classification had moderate reliability with respect to physicians at various levels of training and had good reliability with respect to attending spine surgeons. Interestingly, the Risser staging was found to have less interobserver and intraobserver reliability overall. The Sanders classification is a reliable and reproducible system and should be in the armamentarium of surgeons who treat adolescent idiopathic scoliosis.
  
  
  METHODS
  Level III.
authors.affiliation: *Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center †Department of Orthopaedic Surgery, Mount Sinai Medical Center Beth Israel Hospital, New York, NY.
authors.forename: Shaleen
authors.initials: S
authors.lastname: Vira
authors.forename: Qasim
authors.initials: Q
authors.lastname: Husain
authors.forename: Cyrus
authors.initials: C
authors.lastname: Jalai
authors.forename: Justin
authors.initials: J
authors.lastname: Paul
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Poorman
authors.forename: Caroline
authors.initials: C
authors.lastname: Poorman
authors.forename: Richard S
authors.initials: RS
authors.lastname: Yoon
authors.forename: Christopher
authors.initials: C
authors.lastname: Looze
authors.forename: Baron
authors.initials: B
authors.lastname: Lonner
authors.forename: Peter G
authors.initials: PG
authors.lastname: Passias
mesh_terms: D000293:Adolescent; D006225:Hand / Q000000981:diagnostic imaging; D006801:Humans; D015588:Observer Variation; D009985:Orthopedics / Q000379:methods; D011859:Radiography; D011897:Random Allocation; D015203:Reproducibility of Results; D012600:Scoliosis / Q000145:classification* / Q000000981:diagnostic imaging; D013131:Spine / Q000000981:diagnostic imaging