ANALYSIS OF THE RELIABILITY OF THE LEE CLASSIFICATION FOR LUMBAR DISC HERNIATIONS

Luan Celso Gonçalves,Rodrigo Goes Medéa De Mendonça,Robert Meves,Nelson Astur,Mariana Kei Toma,Maria Fernanda Silber Caffaro,Alberto Ofenhejm Gotfryd

doi:10.1590/s1808-185120201904221700

Luan Celso Gonçalves, Rodrigo Goes Medéa De Mendonça + Show 5 more

Open Access

https://doi.org/10.1590/s1808-185120201904221700

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Abstract

ABSTRACT Objective To evaluate the intra- and interobserver reliability of the Lee et al. classification for migrated lumbar disc herniations. Methods In 2018, Ahn Y. et al. demonstrated the accuracy of this classification for radiologists. However, magnetic resonance images are often interpreted by orthopedists. Thus, a cross-sectional study was conducted by evaluating the magnetic resonance images of 82 patients diagnosed with lumbar disc herniation. The images were evaluated by 4 physicians, 3 of whom were spinal orthopedic specialists and 1 of whom was a radiologist. The intra- and interobserver analysis was conducted using the percentage of concordance and the Kappa method. Results The report of the classifications used by the four observers had a higher proportion of “zone 3” and “zone 4” type classifications in both evaluation moments. The most affected anatomical levels were L5-S1 (48.2%) and L4-L5 (41.4%). The intra- and interobserver concordance, when comparing both moments evaluation of the complementary examinations of the participants involved, was classified as moderate and very good. Conclusions Lee’s classification presented moderate to very good intra- and interobserver reliability for the evaluation of migrated lumbar disc herniation. Level of evidence II; Retrospective Study.

Highlights

Disc herniations are displacements of intervertebral disc material beyond the physiological margins of the intervertebral space and are characterized in the axial plane as protrusions or extrusions
Sequestrated disc or free disc fragment is the term used in cases where the herniated fragment has no continuity with the rest of the disc.[3]
Percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive, video-assisted surgical procedure for removal of the herniated disc fragment that has been gaining in popularity

Summary

Introduction

Disc herniations are displacements of intervertebral disc material beyond the physiological margins of the intervertebral space and are characterized in the axial plane as protrusions or extrusions. Percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive, video-assisted surgical procedure for removal of the herniated disc fragment that has been gaining in popularity Despite the advantages it offers over the traditional discectomy technique, such as low surgical morbidity, lower rate of postoperative pain, and shorter hospital stay,[4] the procedure has a relatively long learning curve.[5] In addition, the accurate positioning of the endoscope at the time of surgery is dependent on the exact assessment of the location of the herniated disc fragment. The classification proposed by Lee et al in 2007 has been used to determine the degree of migration of the herniated disc fragment and helps to determine the possibility of endoscopic resection of the herniation

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Discussion

Conclusion