Clinical validity of two different grading systems for lumbar central canal stenosis: Schizas and Lee classification systems.

Yeon-Jee Ko,Joong Mo Ahn,Jungheum Cho,Joon Woo Lee,Eugene Lee,Chi Young Park,Yusuhn Kang,Michael G Fehlings

doi:10.1371/journal.pone.0233633

Yeon-Jee Ko, Joong Mo Ahn + Show 6 more

Open Access

https://doi.org/10.1371/journal.pone.0233633

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Journal: PloS one	Publication Date: May 27, 2020
Citations: 16	License type: CC BY 4.0

Affiliation: Seoul National University Bundang Hospital

Abstract

ObjectiveTo assess the learnability of two magnetic resonance imaging (MRI) grading systems for lumbar central canal stenosis based on inter-observer agreement and test-retest reliability of doctors with no prior knowledge of the two systems.Materials and methodsTwo clinical fellows, one novice radiology resident, one neurosurgeon, and one orthopedic surgeon, who were unaware of the two qualitative MRI grading systems prior to this study, acquainted themselves with the teaching files. All five observers independently assessed the LCCS grade of 70 patients using T2-weighted axial magnetic resonance images at the L2-3, L3-4, L3-4, and L5-S1 disc levels. Analysis was performed twice at an interval of two months.ResultsThe inter-observer agreement among all five readers was excellent and test-retest reliability was moderate to excellent for both the Schizas and Lee systems. Positive percentage agreements were found to be over 0.8 in almost all observers with relatively narrow 95% confidence limits.ConclusionBoth Schizas and Lee MRI grading systems for LCCS are reliable grading systems, and can be used as a learnable method for both clinicians and radiologists.

Highlights

Lumbar central canal stenosis (LCCS) is defined as the narrowing of the central spinal canal caused by degenerative changes with compression of neural and vascular structures, resulting in various degrees of clinical disability [1]
The problem is that there is no clear consensus on the grading system used in the actual clinical field [8], that the criteria for the diagnosis are inconsistent from those of radiologists and clinicians [9], and that these problems affect the area of research
A total of 70 patients were eligible to be included in the analysis, and a total of 280 disc levels with T2-weighted axial magnetic resonance images were analyzed for LCCS grading

Summary

Materials and methods

One novice radiology resident, one neurosurgeon, and one orthopedic surgeon, who were unaware of the two qualitative MRI grading systems prior to this study, acquainted themselves with the teaching files. Analysis was performed twice at an interval of two months

Results

Introduction

Discussion