Reliability and reproducibility of computed tomography-based facet joint measurements in patients with AO spine type A2, A3 and A4 thoracolumbar fractures: protocol for the REFACT study

Andrey Grin; Aleksandr Talypov; Anton Kordonskiy; Vasiliy Karanadze; Ivan Lvov; Mikhail Kucherov; Rinat Abdrafiev; Aleksandr Tupikin; Layla Khamidova; Roman Elokhovskiy; Ksenia Dmitrenko; Maria Nanoyan; Olga Minkina

doi:10.18203/2349-3259.ijct20263757

Authors

Andrey Grin Department of Neurosurgery, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia https://orcid.org/0000-0003-3515-8329
Aleksandr Talypov Department of Neurosurgery, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia https://orcid.org/0000-0002-6789-8164
Anton Kordonskiy Department of Neurosurgery, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia https://orcid.org/0000-0001-5344-3970
Vasiliy Karanadze Department of Neurosurgery, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia https://orcid.org/0000-0003-0180-9154
Ivan Lvov Department of Neurosurgery, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia https://orcid.org/0000-0003-1718-0792
Mikhail Kucherov Department of Neurosurgery, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia https://orcid.org/0009-0006-9501-7287
Rinat Abdrafiev Department of Neurosurgery, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia https://orcid.org/0000-0003-3328-8349
Aleksandr Tupikin Department of Neurosurgery, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia https://orcid.org/0009-0005-7643-9938
Layla Khamidova Department of Radiology, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia https://orcid.org/0000-0002-9669-9164
Roman Elokhovskiy Department of Radiology, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia https://orcid.org/0009-0005-5974-9846
Ksenia Dmitrenko Department of Radiology, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia https://orcid.org/0009-0002-9453-3520
Maria Nanoyan Department of Radiology, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia https://orcid.org/0000-0001-8617-4893
Olga Minkina Department of Radiology, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia https://orcid.org/0009-0008-3301-1474

DOI:

https://doi.org/10.18203/2349-3259.ijct20263757

Keywords:

Facet joint, Pathria classification, Computed tomography, Interobserver agreement, Intraobserver agreement, Thoracolumbar spine, Joint-space width, Facet joint angle

Abstract

Background: Computed tomography (CT) is widely used to assess facet joint (FJ) degeneration. However, previous studies have reported inconsistent interobserver agreement for the Pathria classification, while the reproducibility of quantitative FJ measurements remains insufficiently investigated. The REFACT study aims to evaluate the interobserver and intraobserver reliability of CT-based FJ assessment in patients with AO spine type A2, A3, and A4 thoracolumbar fractures.

Methods: REFACT is a single center, multiobserver reliability study using retrospectively collected, anonymized CT datasets. Six independent raters (three neurosurgeons and three radiologists) will assess at least 142 evaluable FJs using a standardized protocol. Assessments will include Pathria grading, mean FJ-space width, and FJ angle measurements. Each rater will perform two assessment rounds with randomized case order and a one-month washout interval. Interobserver and intraobserver reliability will be evaluated using intraclass correlation coefficients (ICC) for continuous measurements and Fleiss’ kappa or weighted kappa coefficients for ordinal grading, with 95% confidence intervals. Exploratory analyses will assess agreement by specialty, vertebral level, and side. Patient-level clustered bootstrap analyses will account for within-patient correlation.

Conclusions: The REFACT study will establish the reproducibility of CT-based FJ grading and morphometric measurements, identify potential limitations of the standardized assessment protocol, and provide a methodological basis for subsequent longitudinal studies of FJ degeneration following thoracolumbar fractures.

Trial Registration: ClinicalTrials.gov, NCT07670039.

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