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.

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. 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? 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). 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. 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. • The Vertebral Kyphotic Angle (VKA) demonstrated superior (excellent) reliability for pre- and post-operative assessment compared to the moderate reliability of vertebral body Height (VBH) measurements. • Quantifying the change in deformity post-surgery (responsiveness) proved less reliable, showing only moderate agreement between raters for both VKA and VBH. • The two DICOM software platforms, OsiriX MD and Weasis, showed no significant difference in results, establishing them as interchangeable for these measurements. • For evaluating osteoporotic vertebral compression fractures, VKA is more trustworthy radiographic parameter over VBH.