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Original Article · Open access

Professional experience and reliability of cervical vertebral maturation staging among unfamiliar raters

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Yiğit Umur Cırdı

Department of Orthopedics and Traumatology, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Türkiye

ORCID: 0000-0003-4804-8823

Alp Er Tunga Bölükbaşı

Department of Orthopedics and Traumatology, Acıbadem Ataşehir Hospital, İstanbul, Türkiye

ORCID: 0009-0004-7737-8236

Mehmet Oğuz Çolak

Department of Orthopedics and Traumatology, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Türkiye

ORCID: 0009-0009-8399-1367

Enes Kanay

Department of Orthopedics and Traumatology, Acıbadem Ataşehir Hospital, İstanbul, Türkiye

ORCID: 0000-0003-3669-3884

Danyal Gümüş

Department of Orthopedics and Traumatology, Acıbadem Ataşehir Hospital, İstanbul, Türkiye

ORCID: 0000-0002-8985-8219

Mehmet Demirel

Department of Orthopedics and Traumatology, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Türkiye

ORCID: 0000-0003-1131-7719

Okan Özkunt

Department of Orthopedics and Traumatology, Biruni University, İstanbul, Türkiye

ORCID: 0000-0002-6768-959X

Kerim Sarıyılmaz

Department of Orthopedics and Traumatology, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Türkiye

ORCID: 0000-0002-8680-1428

Abstract

Objectives: This study aims to evaluate the reliability of cervical vertebral maturation (CVM) staging in determining skeletal maturity in patients with adolescent idiopathic scoliosis (AIS), focusing on the effect of professional experience among orthopedic surgeons.

Patients and methods: Between January 2023 and January 2025, this reliability and agreement study included a total of 72 patients aged between nine and 16 years who were diagnosed with AIS. Intra- and inter-rater reliability were analyzed using weighted kappa (κ) statistics with standard errors (SEs) and 95% confidence intervals (CIs). A total of 72 full-spine lateral radiographs were independently assessed by 10 raters with varying levels of orthopedic expertise, including medical students, residents, consultants, and spinal surgeons. None of the raters had prior experience with the CVM classification. Each rater performed CVM staging twice with a four-week interval between assessments.

Results: Of the patients, 33 were male and 39 were female with a mean age of 13.07 ± 1.97 (range, 9 to 16) years. Overall intra-rater reliability was substantial (κ = 0.64, SE = 0.032, 95% CI: 0.569-0.714), and overall inter-rater reliability was moderate (κ = 0.52). Although spinal surgeons showed slightly higher intra-rater reliability overall, inter-rater reliability declined between assessments (first assessment κ = 0.61 vs. second assessment κ = 0.34). Consultants exhibited the highest inter-rater agreement (κ = 0.62), whereas residents showed improvement between assessments (κ = 0.40 vs. 0.52); however, no significant difference observed between groups.

Conclusion: The reliability of CVM staging for assessing skeletal maturity in AIS patients does not significantly differ across levels of orthopedic expertise. While CVM staging has potential as a radiation-sparing method, the overall moderate agreement, particularly among physicians without prior experience, indicates that reliability is not significantly influenced by professional experience.

Declarations

Author Contributions

Y.U.C.: Idea/concept; Y.U.C., M.D.: Design, writing the article; K.S., O.Ö.: Control/supervision; A.E.T.B., D.G., E.K., M.O.Ç., M.D., K.S., O.Ö.: Data collection and/or processing; M.D., O.Ö.: Analysis and/or interpretation; Y.U.C., M.D., K.S., M.O.Ç.: Literature review; O.Ö., K.S.: Critical review; Y.U.C., M.O.Ç.: References and fundings; M.O.Ç.: Materials. All authors approve of the content of the manuscript and agree to be held accountable for the work.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

AI Disclosure

The authors declare that artificial intelligence (AI) tools were not used, or were used solely for language editing, and had no role in data analysis, interpretation, or the formulation of conclusions. All scientific content, data interpretation, and conclusions are the sole responsibility of the authors. The authors further confirm that AI tools were not used to generate, fabricate, or ‘hallucinate’ references, and that all references have been carefully verified for accuracy.

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