ArticleEinstein (Sao Paulo, Brazil)2026
Intra- and inter-observer reliability of spinal inflection point localization: a cross-sectional radiographic study.
Article in Einstein (Sao Paulo, Brazil), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo assess the intra- and inter-observer reliability of spinal inflection point localization on lateral radiographs of asymptomatic adults using a standardized measurement protocol, given its important role in sagittal alignment analysis and its potential influence on biomechanical interpretation and surgical planning.
methodsThis cross-sectional study included 10 adults (five males and five females; age range 32-50 years) without spinal deformities or prior spinal surgery. Lateral and anteroposterior panoramic radiographs were obtained according to the institutional protocol. Three independent orthopedic residents with less than two years of experience assessed the cervicothoracic and thoracolumbar spinal inflection points using Surgimap® software in three separate rounds, conducted at three-week intervals. The spinal inflection point was defined as the vertebral level at which curvature direction changes, according to the method described by Berthonnaud et al. Inter-observer agreement was evaluated using Cohen's kappa index with 95% confidence intervals, and intra-observer reproducibility was assessed using the intraclass correlation coefficient (ICC).
resultsThe most frequent cervicothoracic spinal inflection point was C7-T1, whereas the most common thoracolumbar spinal inflection point was T12-L1. Inter-observer agreement for the cervicothoracic spinal inflection point ranged from kappa 0.19 (95% confidence interval: -0.15 to 0.55) to 0.41 (0.05-0.75), and intra-observer ICC ranged from 0.29 (0.07-0.54) to 0.56 (0.33-0.74). For the thoracolumbar spinal inflection point, inter-observer kappa ranged from -0.03 (-0.20 to 0.14) to 0.22 (0.01-0.44), whereas ICC ranged from 0.29 (0.08-0.53) to 0.56 (0.35-0.72). Wide confidence intervals suggested low precision, likely related to the small sample size and evaluator experience.
conclusionIn this sample, localization of the spinal inflection point by non-specialist evaluators showed low intra- and inter-observer agreement, indicating limited reliability and highlighting the need for standardized protocols or additional training.
Indexed as
Identifiers
What Socratic holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.