jsmc-10210

INTER-OBSERVER AGREEMENT IN MRI ASSESSMENT OF LUMBER INTERVERTEBRAL DISCS AND NERVE ROOTS USING PFIRRMAN CLASSIFICATION

Shahla Mohammed Saeed a, Abeer Kadum Abass a, and Mariwan Mahmood Rasool b

a Department of Surgery, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.

b Qaladiza General Teaching Hospital

Submitted: 15/3/2019; Accepted: 29/7/2019; Published: 21/9/2019

DOI Link: https://doi.org/10.17656/jsmc.10210

ABSTRACT

Background

Low back pain is a common medical condition and is a major health and economic problem. Intervertebral disc degeneration grading is crucial in the evaluation of many degenerative spine conditions including low back pain.MRI is considered the best imaging technique to evaluate intervertebral disc degenerative changes. Back pain is the most common indication for imaging of the spine. A morphologic Pfirrman grading system is commonly used to classify spinal degenerative changes ( intervertebral discs & nerve roots).

Objectives

The aim of this study was to evaluate the degree of independent interobserver agreement using Pfirrman classification in the assessment of disc degenerations and nerve root compromise.

Patients and Methods

This study was conducted in Sulaimani, Kurdistan Region, Iraq at the diagnostic imaging center in Sulaimania during the period of 21st April 2015 to 21st October 2015 for 50 patients with low back pain. The same images were interpreted by two radiologists independently for grades of disc degeneration and nerve root compromise using Ppfirrmann classification system, up to the authors' knowledge this is the first study in the Kurdistan Region that depends on interobserver agreement regarding MRI interpretations concerning degenerative lumbar spine changes.

Results

The interobserver agreement in our study for Pfirrman grades of disc degeneration and nerve root compromise was moderate with Kappa values of (K= 0.431) and (K=0.417) respectively.

Conclusion

Pfirrman classification system is reliable and provides a standardized assessment of lumbar intervertebral disc and nerve roots.

KEYWORDS

Disc degeneration, Lumber MRI, Back pain.

References

1. Osborn, Ross, Salzman, Crim, Borg, Moore, Shah Jhaveri, Hamilton , Blaser, Katzman. Expert Differential Diagnosis brain and Spine. First edition. Amirsys, 2009. Spine II. Page: 52.

2. O. Airaksinen, J. I. Brox, C. Cedraschi et al, European guidelines for The management of chronic nonspecific low back pain, chapter 4 , Eur Spine J (2006) 15 (Suppl. 2): S 208.

3. Stephanie Ryan, Michelle McNicholas, Stephen Eustace. Anatomy for Diagnostic Imaging, second edition 2004, Page: 100-104.

4. David Sutton. Textbook Of Radiology And Imaging. Seventh edition 2002, neuroradiology of the spine. Page: 1643. Battie MC, Videman T. Lumbar disc degeneration: epidemiology and genetics. J Bone Joint Surg Am 2006; 882: 3-9.

5. Antoniou J, Steffen T, Nelson F, Winterbottom N et al. The Human Lumbar Intervertebral Disc: Evidence for Changes in the Biosynthesis and Denaturation of the Extracellular Matrix with Growth, Maturation, Ageing and Degeneration. J. Clin.Invest.1996; 98:996–1003.

7. Yu L-P, Qian W-W, Yin G-Y, Ren Y-X, Hu Z-Y (2012) MRI Assessment of Lumbar Intervertebral Disc Degeneration with Lumbar Degenerative Disease Using the Pfirrmann Grading Systems. PLoS ONE 7(12): e48074, page: 1.

8.Modic MT, Masaryk TJ, Ross JS, et al. Imaging of degenerative disk disease. Radiology 1988; 168:177–86.

9. Pearce RH, Thompson JP, Bebault GM, et al. Magnetic resonance Imaging reflects the chemical changes of aging degeneration in the human intervertebral disk. J Rheumatol Suppl 1991; 27:42–3.

10. Sether LA, Yu S, Haughton VM, et al. Intervertebral disk: normal Age-related changes in MR signal intensity. Radiology 1990; 177:385–8.

11. Timothy L. Tan, BS1, Sean L. Borkowski, MS2, Sophia Nicole Sangiorgio, et al. Quantification and Classification of Lumbar Disc Degeneration. http://www.ors.org/Transactions/60/0747.pdf

12. Christian W. A. Pfirrmann, Alexander Metzdorf, Marco Zanetti et al. Magnetic Resonance Classification of Lumbar Intervertebral Disc Degeneration. Spine 2001; 26:1874-1878.

13. Christian W. A. Pfirrmann, Claudio Dora, Marius R. Schmid et al. MR image- based grading of lumbar nerve root compromise due to disk Herniation: reliability study with surgical correlation. Radiology 2004; 230: 583-8.

14.Antony J. Viera, Joanne M. Garret . Understanding Interobserver Agreeement : The Kappa Statistics. FamMed 2005; 37:360-3.

15.Landis JR, Koch GG.The measurmnt of observer agreement for categorical data.Biometrics 1977;33:159-174.

16. Carrino JA, Lurie JD, Tosteson AN, Tosteson TD. Lumbar spine: reliability of MR imaging findings. Radiology 2009; 250:161-70.

17.Estanislao Arana, Ana Royuela , Francisco M. Kovacs et al. Agreement in the Interpretation of 1.5-T MR Images by Using the Nordic Modic Consensus Group Classification Form. Radiology 2010; 254:809-817.

18. Kovacs FM, Royuela A, Jensen TS et al .Agreement in the interpretation of magnetic resonance images of the lumbar spine. Acta Radiol 2009; 50:497–506 .

19. S Verma, P Gupta, A Munshi at al. A Retrospective Analysis Of Magnetic Resonance Imaging Findings In 20 -40 Year Old Patients With Low Back Pain. Experience At A Semi Urban Tertiary Healthcare Centre In Northern India. The Internet Journal of Spine Surgery. 2010 Volume 6. Number 1.

20.Shafaq Saleem, Hafiz Muhammed Aslam, Muhammad Aim Khan Rehmani et al. Lumbar Disc Degenerative Disease: Disc Degeneration Symptoms and Magnetic Resonance Image Findings. Asian Spine J 2013;7(4):322-334

21.Jon D. Lurie, Anna N. A. Tosteson, Tor D. Tosteson et al. Reliability of Magnetic Resonance Imaging Readings for Lumbar Disc Herniation in the Spine Patient Outcomes Research Trial (SPORT). Spine (Phila Pa 1976) 2008; 33: 991–9

Full Text

This work is licensed under a Creative Commons Attribution 4.0 International License.