ArticleBrain & spine2026
Comparing the intra- and inter-rater reliability of two outcomes, two software platforms, and three levels of surgical experience for radiographic measurements of surgically treated osteoporotic vertebral compression fractures.
Article in Brain & spine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Osteoporotic vertebral compression fractures (OVCFs) present diagnostic challenges, especially in elderly patients with low bone density. Radiographic measurement is key to surgical decision-making, but their reliability in these patients with lower radiological density is questionable. Research question: What is the intra- and inter-rater reliability and responsiveness to the measurement of two commonly used radiographic parameters-vertebral kyphotic angle (VKA) and vertebral body height (VBH)-using two different DICOM software platforms for patients undergoing surgical treatment for OVCFs? Material and methods: Patients treated surgically for OVCFs were randomly extracted. Sagittal vertebral body deformity was evaluated using the VKA and the VBH (pre-operative, post-operative and change over time). One operator repeated measurements with one-month interval (intra-rater reliability), using two software platforms (OsiriX MD and Weasis). Three randomly assigned surgeons per platform performed blindly measurements (inter-rater). Reliability was assessed using intraclass correlation coefficients (ICC). Results: Thirty-four patients (71% females; mean age 75.3 ± 9.4 years) were included. Intra-rater and inter-rater reliability were reported as good-to-excellent (ICC: 0.75-0.90) for VKA, and good-to-moderate (ICC: 0.50-0.75) for VBH. Reliability for measuring post-operative change was moderate for both outcomes. Both software platforms perform comparably with good agreement. Discussion and conclusions: This was the first study to assess the reliability and responsiveness of postoperative radiographic changes in OVCF surgery across two different software platforms. VKA is a more reliable measurement than VBH. These findings support using VKA to guide treatment and monitoring recovery, although measurement error remain important considerations in elderly patients with low bone density.
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