{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T01:18:20Z","timestamp":1772068700818,"version":"3.50.1"},"reference-count":22,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,1,20]],"date-time":"2025-01-20T00:00:00Z","timestamp":1737331200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Coronal malalignment is a common feature of adult spinal deformity, and accurate classification is essential for diagnosis and treatment planning. However, variations in interpretation among clinicians can impact classification consistency. By assessing the reliability and applicability of these systems across different medical experts, this study seeks to establish a standardized approach to enhance clinical outcomes. This study aimed to evaluate the inter\u2010 and intra\u2010observer agreement of two classification systems for coronal malalignment in adult spinal deformity patients, as proposed by Qiu et\u00a0al. and Obeid et\u00a0al.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We analyzed 70 cases of adult spinal deformity collected between January 1, 2010, and April 20, 2023, using the classification systems proposed by Qiu et\u00a0al. and Obeid et\u00a0al. To assess inter\u2010 and intra\u2010rater agreement, the same group of researchers re\u2010evaluated all cases in a random order after a 4\u2010week interval. We used the kappa statistic (<jats:italic>\u03ba<\/jats:italic>) for inter\u2010 and intra\u2010rater agreement assessment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Qiu's classification system: Inter\u2010rater agreement: Substantial agreement (<jats:italic>\u03ba<\/jats:italic>\u2009=\u20090.76; 95% CI: 0.72\u20130.80) for Type A, Type B, and Type C. Intra\u2010rater agreement: Nearly perfect agreement (<jats:italic>\u03ba<\/jats:italic>\u2009=\u20090.83; 95% CI: 0.78\u20130.89) within raters for Type A, Type B, and Type C.<\/jats:p><jats:p>Obeid's classification system: Inter\u2010rater agreement: Almost perfect agreement (<jats:italic>\u03ba<\/jats:italic>\u2009=\u20090.85; 95% CI: 0.83\u20130.87) for Type 0, Type 1, and Type 2. Complete system: Substantial agreement (<jats:italic>\u03ba<\/jats:italic>\u2009=\u20090.68; 95% CI: 0.65\u20130.71) for all types and subtypes. Intra\u2010rater agreement: Almost perfect at the type level (<jats:italic>\u03ba<\/jats:italic>\u2009=\u20090.88; 95% CI: 0.83\u20130.93) and substantial at the subtype level (<jats:italic>\u03ba<\/jats:italic>\u2009=\u20090.75; 95% CI: 0.65\u20130.85).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The research findings indicate a high level of agreement between the classification system described by Qiu et\u00a0al. and the classification system proposed by Obeid et\u00a0al. This agreement supports the widespread adoption and utilization of these classification systems in future clinical studies.<\/jats:p><\/jats:sec>","DOI":"10.1111\/os.14356","type":"journal-article","created":{"date-parts":[[2025,1,20]],"date-time":"2025-01-20T23:19:52Z","timestamp":1737415192000},"page":"1075-1085","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["An Inter\u2010 and Intra\u2010Rater Agreement Assessment of Two Novel Classification Systems for Coronal Imbalance in Adult Scoliosis and Spine Deformity"],"prefix":"10.1111","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-9315-177X","authenticated-orcid":false,"given":"Muradil","family":"Mardan","sequence":"first","affiliation":[{"name":"Department of Spine Center Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine  Shanghai 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