Revalidating Pfirrmann's Magnetic Resonance Image-Based Grading of Lumbar Nerve Root Compromise by Calculating Reliability among Orthopaedic Residents.
10.4055/cios.2018.10.2.210
- Author:
Arun Kumar KALIYA-PERUMAL
1
;
Senthil Kumar ARIPUTHIRAN-TAMILSELVAM
;
Chi An LUO
;
Sivaharivelan THIAGARAJAN
;
Udhayakumar SELVAM
;
Raj Prabhakar SUMATHI-EDIROLIMANIAN
Author Information
1. Department of Orthopaedic Surgery, Melmaruvathur Adhiparasakthi Institute of Medical Sciences and Research, Affiliated to the Tamil Nadu Dr MGR Medical University, Tamil Nadu, India. senthilbonearch@gmail.com
- Publication Type:Original Article
- Keywords:
Intervertebral disc;
Nerve root compression;
Spinal stenosis;
Radiculopathy;
Reliability
- MeSH:
Humans;
Intervertebral Disc;
Male;
Radiculopathy;
Spinal Stenosis
- From:Clinics in Orthopedic Surgery
2018;10(2):210-215
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: Intervertebral disc herniations lead to subsequent compromise of the nerve root. The root can either have a mere contact with the disc material or be pushed aside or compressed. This was earlier graded by Pfirrmann and colleagues. We intend to revalidate this grading system by performing a reliability analysis among orthopaedic residents. METHODS: Fifty axial cut magnetic resonance (MR) images of the affected lumbar disc level that belonged to different patients (age, 37.8 ± 10.4 years; 33 males and 17 females) were chosen and given to five orthopaedic residents for grading according to the Pfirrmann's MR image-based grading of lumbar nerve root compromise. Responses were received in the form of categorical variables and reliability was assessed. RESULTS: On doing percentage statistics, we found that 14 images had 100% agreement, 22 had 80% agreement and 14 had 60% agreement. We inferred an overall agreement of 80% ± 15.1%. In addition, interrater reliability was determined by calculating the Fleiss' kappa, which was found to be 0.521, signifying moderate agreement. Intrarater reliability was determined by calculating Cohen's kappa, which was found to be 0.696, signifying substantial agreement. CONCLUSIONS: Our residents took only a short time to learn and reproduce this grading system as ratings that proved to be moderately reliable. Even though the value of kappa was slightly lower, reliability was similar to that of the original authors. We think that this grading system can be adopted in day-to-day practice by framing appropriate rules to interpret MR images where the nerve roots are not visible.
