Predictive Value and Interrater Reliability of Radiographic Factors in Neurofibromatosis Patients With Dystrophic Scoliosis

A. Noelle Larson, Charles Gerald T. Ledonio, Ann M Brearley, Daniel J. Sucato, Leah Y. Carreon, Alvin H. Crawford, David A. Stevenson, Michael G. Vitale, Christopher L Moertel, David W Polly

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Background: Scoliosis in patients with neurofibromatosis type I (NF1) can manifest as dystrophic or nondystrophic curves. Dystrophic scoliosis is rapidly progressive, rendering treatment challenging. Radiographic characteristics have been reported to predict dystrophic scoliosis, but their reliability and predictive value have not been well described. The purpose of this study is to assess the interobserver reliability for eight radiographic characteristics of dystrophic scoliosis and to evaluate the sensitivity and specificity of these characteristics relative to the gold standard of a definitive clinical diagnosis. Methods: Spine radiographs of 122 NF1 patients from multiple institutions were graded by five spine surgeons as dystrophic or nondystrophic, based on eight radiographic characteristics of dystrophic modulation: rib penciling, vertebral rotation, scalloping, wedging, spindling of transverse processes, short sharp angular curve, widened interpedicular distance, and atypical location. The curves were classified by each submitting institution as dystrophic or nondystrophic based on clinical outcome. Interobserver reliability analysis was performed using Fleiss kappa. Results: For the 122 cases, the interrater agreement among the five readers for the diagnosis of dystrophic scoliosis was good at 0.61. The agreement for individual radiographic characteristic ranged from 0.62 for wedging to 0.14 (poor) for scalloping. Surgeons underestimated the number of dystrophic curves, rating from 45% to 67% of the curve patterns as dystrophic, compared to the gold standard, which revealed 68% of the curves to be dystrophic. On multivariate analysis, rib penciling, vertebral rotation, vertebral wedging, and atypical location were significantly associated with true dystrophic status (odds ratios of 2.4, 3.0, 2.4, and 3.0, respectively). Conclusion: Overall dystrophic diagnosis can be assessed by radiographic characteristics. Better understanding of the predictive value of specific radiographic features may assist in early diagnosis of patients with dystrophic NF and assist surgeons in identifying dystrophic curve patterns and instituting prompt, appropriate treatment. Level of Evidence: Level III.

Original languageEnglish (US)
Pages (from-to)560-567
Number of pages8
JournalSpine Deformity
Issue number5
StatePublished - Sep 1 2018

Bibliographical note

Funding Information:
Research reported in this publication was supported by 1) Department of Defense, Congressionally Directed Medical Research Program, Neurofibromatosis Research Program, Award Number W81HWH-10-1-0469; 2) the National Center for Advancing Translational Sciences of the National Institutes of Health, Award Number UL1TR000114; 3) Shriners Research Foundation; and 4) NIH NINDS K23 NS052500. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Publisher Copyright:
© 2018 Scoliosis Research Society


  • Modulation
  • Neurofibroma
  • Nondystrophic
  • Rib penciling


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