title: A New Radiological Sign for Severe Angular Kyphosis: "The Baltalimani Sign".
abstract: METHODS
  Retrospective diagnostic study.
  
  
  OBJECTIVE
  To define a new radiological sign, "Baltalimani sign," in severe angular kyphosis (SAK) and to report its relationship with the risk of neurological deficits and deformity severity.
  
  
  BACKGROUND
  Baltalimani sign was previously undefined in the literature.
  
  
  METHODS
  We propose Baltalimani sign as the axial orientation of the vertebrae that are located above or below the apex of angular kyphosis on anteroposterior radiographs. Patients with SAK of various etiologies with kyphotic angles ≥90° were selected and evaluated for the presence of Baltalimani sign. Demographic data of the patients including age, gender, etiology, neurological status, local kyphosis angles, and the location of the kyphosis apex were recorded. Sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV) of Baltalimani sign for the risk of the neurological deficits were evaluated by the IBM SPSS ver. 20.0. Ap-values of <0.05 were considered statistically significant. Cohen's kappa was used for analysis of interrater agreement.
  
  
  RESULTS
  The mean local kyphosis angle in all patients was 124.2° (range, 90°-169°), and 15 of 40 (37.5%) patients had neurological deficits. Baltalimani sign was seen in 13 of 15 patients with neurological deficits (p=0.001). Baltalimani sign showed a sensitivity and specificity PPV and NPV of 61.9%, 86.7%, 89.5%, and 68.8% for the risk of the neurological deficits in SAK patients, respectively. Cohen's kappa value was moderate (κ=0.506).
  
  
  CONCLUSIONS
  The detection of Baltalimani sign in SAK may indicate severity of deformity and the risk of neurological deficits.
authors.affiliation: Department of Orthopaedics and Traumatology, Carsamba State Hospital, Samsun, Turkey.
authors.forename: Yunus
authors.initials: Y
authors.lastname: Atici
authors.affiliation: Department of Orthopaedics and Traumatology, Sanliurfa Siverek State Hospital, Sanliurfa, Turkey.
authors.forename: Osman Emre
authors.initials: OE
authors.lastname: Aycan
authors.affiliation: Department of Orthopaedic Surgery, Metin Sabanci Baltalimani Bone Diseases Training and Research Hospital, Samsun, Turkey.
authors.forename: Muhammed
authors.initials: M
authors.lastname: Mert
authors.affiliation: Department of Orthopaedic Surgery, Metin Sabanci Baltalimani Bone Diseases Training and Research Hospital, Samsun, Turkey.
authors.forename: Deniz
authors.initials: D
authors.lastname: Kargin
authors.affiliation: Department of Orthopaedic Surgery, Metin Sabanci Baltalimani Bone Diseases Training and Research Hospital, Samsun, Turkey.
authors.forename: Akif
authors.initials: A
authors.lastname: Albayrak
authors.affiliation: Department of Orthopaedic Surgery, Metin Sabanci Baltalimani Bone Diseases Training and Research Hospital, Samsun, Turkey.
authors.forename: Mehmet Bulent
authors.initials: MB
authors.lastname: Balioglu
keywords: Baltalimani; Kyphosis; Radiological; Severe; Sign