Luca Papavero1, Carlos J Marques2,3, Jens Lohmann1, Thies Fitting4, Kathrin Schawjinski1, Nawar Ali1, Hauke Hillebrand1, Rainer Maas5. 1. Clinic for Spine Surgery, Schoen Clinic Hamburg Eilbek, Academic Hospital of the University of Hamburg, Dehnhaide 120, 22081, Hamburg, Germany. 2. Science Office of the Orthopedic and Joint Replacement Department, Schoen Clinic Hamburg Eilbek, Dehnhaide 120, 22081, Hamburg, Germany. cmarques@schoen-klinik.de. 3. Non-Medical PhD Program, Faculty of Medicine, University of Hamburg, Hamburg, Germany. cmarques@schoen-klinik.de. 4. Department of Radiology at the Schoen Clinic Hamburg Eilbek, Academic Hospital of the University of Hamburg, Dehnhaide 120, 22081, Hamburg, Germany. 5. Radiology Office Raboisen 38, Hamburg, Germany.
Abstract
PURPOSE: Patients with central lumbar spinal stenosis (LSS) have a longer symptom history, more severe stenosis, and worse postoperative outcomes, when redundant nerve roots (RNRs) are evident in the preoperative MRI. The objective was to test the inter- and intra-rater reliability of an MRI-based classification for RNR. METHODS: This is a retrospective reliability study. A neuroradiologist, an orthopedic surgeon, a neurosurgeon, and three orthopedic surgeons in-training classified RNR on 126 preoperative MRIs of patients with LSS admitted for microsurgical decompression. On sagittal and axial T2-weighted images, the following four categories were classified: allocation (A) of the key stenotic level, shape (S), extension (E), and direction (D) of the RNR. A second read with cases ordered differently was performed 4 weeks later. Fleiss and Cohen's kappa procedures were used to determine reliability. RESULTS: The allocation, shape, extension, and direction (ASED) classification showed moderate to almost perfect inter-rater reliability, with kappa values (95% CI) of 0.86 (0.83, 0.90), 0.62 (0.57, 0.66), 0.56 (0.51, 0.60), and 0.66 (0.63, 0.70) for allocation, shape, extension, and direction, respectively. Intra-rater reliability was almost perfect, with kappa values of 0.90 (0.88, 0.92), 0.86 (0.84, 0.88), and 0.84 (0.81, 0.87) for shape, extension, and direction, respectively. Intra-rater kappa values were similar for junior and senior raters. Kappa values for inter-rater reliability were similar between the first and second reads (p = 0.06) among junior raters and improved among senior raters (p = 0.008). CONCLUSIONS: The MRI-based classification of RNR showed moderate-to-almost perfect inter-rater and almost perfect intra-rater reliability.
PURPOSE:Patients with central lumbar spinal stenosis (LSS) have a longer symptom history, more severe stenosis, and worse postoperative outcomes, when redundant nerve roots (RNRs) are evident in the preoperative MRI. The objective was to test the inter- and intra-rater reliability of an MRI-based classification for RNR. METHODS: This is a retrospective reliability study. A neuroradiologist, an orthopedic surgeon, a neurosurgeon, and three orthopedic surgeons in-training classified RNR on 126 preoperative MRIs of patients with LSS admitted for microsurgical decompression. On sagittal and axial T2-weighted images, the following four categories were classified: allocation (A) of the key stenotic level, shape (S), extension (E), and direction (D) of the RNR. A second read with cases ordered differently was performed 4 weeks later. Fleiss and Cohen's kappa procedures were used to determine reliability. RESULTS: The allocation, shape, extension, and direction (ASED) classification showed moderate to almost perfect inter-rater reliability, with kappa values (95% CI) of 0.86 (0.83, 0.90), 0.62 (0.57, 0.66), 0.56 (0.51, 0.60), and 0.66 (0.63, 0.70) for allocation, shape, extension, and direction, respectively. Intra-rater reliability was almost perfect, with kappa values of 0.90 (0.88, 0.92), 0.86 (0.84, 0.88), and 0.84 (0.81, 0.87) for shape, extension, and direction, respectively. Intra-rater kappa values were similar for junior and senior raters. Kappa values for inter-rater reliability were similar between the first and second reads (p = 0.06) among junior raters and improved among senior raters (p = 0.008). CONCLUSIONS: The MRI-based classification of RNR showed moderate-to-almost perfect inter-rater and almost perfect intra-rater reliability.
Authors: Hasan Banitalebi; Ansgar Espeland; Masoud Anvar; Erland Hermansen; Christian Hellum; Jens Ivar Brox; Tor Åge Myklebust; Kari Indrekvam; Helena Brisby; Clemens Weber; Jørn Aaen; Ivar Magne Austevoll; Oliver Grundnes; Anne Negård Journal: BMC Musculoskelet Disord Date: 2022-01-15 Impact factor: 2.362
Authors: Elisabeth Sartoretti; Michael Wyss; Alex Alfieri; Christoph A Binkert; Cyril Erne; Sabine Sartoretti-Schefer; Thomas Sartoretti Journal: Sci Rep Date: 2021-06-07 Impact factor: 4.379