Inter- and Intra-rater Reliability of the Hart-ISSG Proximal Junctional Failure Severity Scale.

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Date

2018-04

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Abstract

Study design

Reliability/external validation study.

Objective

Investigate inter- and intrarater reliability of the Hart-International Spine Study Group (ISSG) Proximal Junctional Failure Severity Scale (PJFSS) and its correlation with operative revision in patients with proximal junctional failure (PJF).

Summary of background data

The Hart-ISSG PJFSS is a validated classification system for PJF. Reliability of the PJFSS has not been assessed.

Methods

Sixteen detailed clinical scenarios were assessed using the ISSG PJFSS classification in six categories: neurologic status, axial pain, instrumentation issue, proximal kyphotic angle, level of upper instrumented vertebrae (UIV), and severity of UIV/UIV+1 fracture. Eleven spine surgeons evaluated each case in all six categories during two different assessments, and provided recommendations regarding operative revision or observation for each case. Inter- and intrarater reliability were calculated based on intraclass correlation coefficients.

Results

All intraclass correlation coefficients demonstrated "almost perfect"' (0.817-0.988) inter-rater agreement for both assessments, except UIV/UIV+1 fracture severity during the second assessment, which demonstrated "substantial" agreement' (0.692). Five of six categories had "almost perfect" mean intrarater reliability (0.805-0.981), while "instrumentation issue" demonstrated "substantial" mean agreement (0.757). Inter-rater reliability for recommendation of surgical intervention was "almost perfect" during both assessments (0.911 and 0.922, respectively). Mean PJFSS scores between the two assessments were significantly higher for cases recommended for operative revision (8.43 ± 0.90) versus cases recommended for observation (P < 0.0001).

Conclusion

The ISSG PJFSS is a reliable and repeatable classification system for assessing patients with PJF. Higher PJFSS scales correlate with recommendation for operative revision, extending prior external validation of the PJFSS.

Level of evidence

3.

Type

Journal article

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Subjects

and the International Spine Study Group, Humans, Spinal Diseases, Observer Variation, Spinal Fusion, Severity of Illness Index, Retrospective Studies, Reproducibility of Results, Aged, Middle Aged, Female, Male, Neurosurgeons

Citation

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https://hdl.handle.net/10161/28332

Published Version (Please cite this version)

10.1097/brs.0000000000002498

Publication Info

Hart, Robert A, Farbod Rastegar, Alec Contag, Marie Kane, Alan Daniels, Eric Klineberg, Robert Eastlack, Justin S Smith, et al. (2018). Inter- and Intra-rater Reliability of the Hart-ISSG Proximal Junctional Failure Severity Scale. Spine, 43(8). pp. E461–E467. 10.1097/brs.0000000000002498 Retrieved from https://hdl.handle.net/10161/28332.

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