Idiopathic scoliosis - The clinical value of radiologists' interpretation of pre- and postoperative radiographs with interobserver and interdisciplinary variability

Study Design. A retrospective analysis of radiographic reports on 161 conse cutive patients with idiopathic scoliosis at the authors' institution. Objectives. To compare various radiographic findings that directly affect s urgical decision-making and the evaluation of postsurgical outcomes to dete rmine the usefulness of information gathered from radiologists' multiple du plicate reading of films. Summary of Background Data. To the authors' knowledge, there are no previou s studies on the readings of scoliosis films by radiologists and surgeons. Methods. The patient pool was drawn from the private practices of two board -certified orthopaedic surgeons. Each set of radiographs was read by one of seven board-certified radiologists and by one of the two surgeons. The two reports of each radiograph were compared. The factors included in the repo rts were scoliosis deformity, scoliosis type, curve progression, curve magn itude, levels of the curve, kyphosis, lordosis, the presence of instrumenta tion, and the presence of a fusion. Results. The radiologists and orthopedic surgeons mentioned the presence of scoliosis in 95% and 99.4% of their reports, respectively. The type of sco liosis was mentioned in 5% of reports by radiologists and in 99.4% by ortho pedists. Progression of the curve was documented in 16.7% of the radiologis ts' reports and in 98.4% of orthopedists' reports, The magnitude of the cur ve was slated in 12.6% of the radiologists' reports, compared with 98.1% of the orthopaedists' reports. The levels of the curve were documented in 10. 6% and 95.6% of reports by the radiologists and orthopedists, respectively. Radiologists mentioned kyphosis and lordosis in 28% and 26.5% of reports, respectively. These same two entities were mentioned in 98.2% and 79.4% of reports by the orthopedists. Finally, the radiologists noted the presence o f instrumentation and of a fusion in 77.8% and 68.3% of reports, respective ly. Orthopedists mentioned these same two entities in 84.4% and 100% of rep orts, respectively. In the radiologists' reports on the presence of instrum entation, 20% were mislabeled or improperly identified. Seven percent of th e fusions documented by the radiologists were incorrect because they were r ecorded before biologic fusion could have taken place. In all these categor ies, the radiologists provided information in excess of the orthopedic repo rts a total of 1.9% of the time. Of this 1.9% additional information, 36.8% was incorrectly read or mislabeled. The other 63.2% of the additional info rmation (1.9% of the total) did not elucidate anything of real clinical sig nificance that was missed by the orthopedic surgeons (e.g., a tumor in the lung). Conclusions. These findings show that the attending orthopedic spine surgeo ns gained little useful information from the radiologists' multiple duplica te reading of films.