The Reliability Evaluation of Facet joint Assessment by Computed Tomography in thoracolumbar fractures (REFACT) study aims to evaluate how consistently different specialists assess thoracolumbar facet joints on computed tomography (CT) images in patients with AOSpine type A2, A3, or A4 thoracolumbar fractures.
The main questions are:
* How consistently do different raters classify facet joint degeneration using the Pathria grading system? * How consistently do different raters measure facet joint angle and mean facet joint space width on CT images? * How reproducible are these assessments when the same rater repeats the measurements after a one-month interval?
The study will use anonymized retrospective CT DICOM datasets obtained from the institutional imaging archive. Six independent raters (three neurosurgeons and three radiology specialists) will evaluate the same CT datasets using a standardized measurement protocol. Each rater will perform two independent assessment rounds separated by a one-month washout period. The results will be used to determine the inter-rater and intra-rater reliability of qualitative and quantitative CT-based facet joint assessment methods.
patient age from 18 to 50 years;
thoracolumbar fracture classified as AOSpine type A2, A3, or A4;
availability of CT images covering vertebral levels from Th9 to L3;
absence of imaging artifacts at the levels planned for assessment.
bone density of the thoracolumbar junction vertebrae below 100 HU;
systemic bone or joint disorders associated with changes in the FJs or intervertebral discs, including diffuse idiopathic skeletal hyperostosis, ankylosing spondylitis, rheumatoid arthritis, or other comparable conditions;
previous spinal surgery, including procedures performed without implants;
fractures with distraction or translational injury of the posterior supporting column.