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

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 (x) 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 (kappa = 0.64, SE = 0.032, 95% CI: 0.569-0.714), and overall inter-rater reliability was moderate (kappa = 0.52). Although spinal surgeons showed slightly higher intra-rater reliability overall, inter-rater reliability declined between assessments (first assessment x = 0.61 vs. second assessment kappa = 0.34). Consultants exhibited the highest inter-rater agreement (kappa = 0.62), whereas residents showed improvement between assessments (kappa = 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.