Abstract
BackgroundMagnetic Resonance Imaging (MRI) is an important tool in preoperative evaluation of patients with lumbar spinal stenosis (LSS). Reported reliability of various MRI findings in LSS varies from fair to excellent. There are inconsistencies in the evaluated parameters and the methodology of the studies. The purpose of this study was to evaluate the reliability of the preoperative MRI findings in patients with LSS between musculoskeletal radiologists and orthopaedic spine surgeons, using established evaluation methods and imaging data from a prospective trial.MethodsConsecutive lumbar MRI examinations of candidates for surgical treatment of LSS from the Norwegian Spinal Stenosis and Degenerative Spondylolisthesis (NORDSTEN) study were independently evaluated by two musculoskeletal radiologists and two orthopaedic spine surgeons. The observers had a range of experience between six and 13 years and rated five categorical parameters (foraminal and central canal stenosis, facet joint osteoarthritis, redundant nerve roots and intraspinal synovial cysts) and one continuous parameter (dural sac cross-sectional area). All parameters were re-rated after 6 weeks by all the observers. Inter- and intraobserver agreement was assessed by Gwet’s agreement coefficient (AC1) for categorical parameters and Intraclass Correlation Coefficient (ICC) for the dural sac cross-sectional area.ResultsMRI examinations of 102 patients (mean age 66 ± 8 years, 53 men) were evaluated. The overall interobserver agreement was substantial or almost perfect for all categorical parameters (AC1 range 0.67 to 0.98), except for facet joint osteoarthritis, where the agreement was moderate (AC1 0.39). For the dural sac cross-sectional area, the overall interobserver agreement was good or excellent (ICC range 0.86 to 0.96). The intraobserver agreement was substantial or almost perfect/ excellent for all parameters (AC1 range 0.63 to 1.0 and ICC range 0.93 to 1.0).ConclusionsThere is high inter- and intraobserver agreement between radiologists and spine surgeons for preoperative MRI findings of LSS. However, the interobserver agreement is not optimal for evaluation of facet joint osteoarthritis.Trial registrationwww.ClinicalTrials.gov identifier: NCT02007083, registered December 2013.
Highlights
Magnetic Resonance Imaging (MRI) is an important tool in preoperative evaluation of patients with lumbar spinal stenosis (LSS)
Andreisek et al [17] found reported observer agreement values for facet joint osteoarthritis varying from poor to excellent; reliability data were lacking for hypertrophy of the flaval ligaments, redundant nerve roots (RNR) of the cauda equina and reduction of the posterior epidural fat
The aim of this study was to evaluate the reliability of the commonly used, preoperative MRI findings in the assessment of foraminal and central canal stenosis, facet joint osteoarthritis, RNR and intraspinal synovial cysts, using observers with different levels of experiences. The participants in this cross-sectional study were consecutively included from the Spinal Stenosis Trial of the NORwegian Degenerative spondylolisthesis and Spinal STENosis (NORDSTEN) study, a prospective, multicentre, randomised controlled trial that was designed to compare different surgical treatments for LSS [18]
Summary
Magnetic Resonance Imaging (MRI) is an important tool in preoperative evaluation of patients with lumbar spinal stenosis (LSS). Andreisek et al [17] found reported observer agreement values for facet joint osteoarthritis varying from poor to excellent; reliability data were lacking for hypertrophy of the flaval ligaments, redundant nerve roots (RNR) of the cauda equina and reduction of the posterior epidural fat. This lack of consensus on the reliability of MRI findings and insufficient reliability data for some parameters highlights the need for studies with higher quality, higher number of the included patients, and observers from relevant medical specialties
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