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Grading system for migrated lumbar disc herniation on sagittal magnetic resonance imaging: an agreement study

  • Spinal Neuroradiology
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Abstract

Purpose

Migrated lumbar disc herniations (LDHs) in the sagittal plane are common. Disc migration grading can be applied as a useful measurement tool in the diagnosis, treatment, and outcome evaluation of migrated LDH. No study has evaluated the reliability of migrated LDH grading. We evaluated the reliability and functionality of the current magnetic resonance imaging (MRI) grading system for migrated LDH.

Methods

We assessed a six-level grading system developed based on sagittal MRI and graded according to the direction (rostral and caudal) and degree (low, high, and very high) of disc migration. One-hundred and one migrated LDHs treated with minimally invasive endoscopic discectomy were analyzed independently by two experienced radiologists. Intraobserver and interobserver agreements were assessed by kappa statistics.

Results

The most common migrated LDH grade was grade 4 (30.94%; caudal, low-grade migration). Rostral and caudal migrations were more common in the upper and lower lumbar levels, respectively. Interobserver agreement in the grading of migrated LDH was good at both the first (kappa = 0.737) and second assessment (kappa = 0.657). The intraobserver agreement for reader 1 was very good (kappa = 0.827) and for reader 2 was good (kappa = 0.620).

Conclusions

The current grading system for migrated LDH was found to be reliable and functional with good interobserver and intraobserver agreement. It may be useful in the interpretation of disc migration patterns and outcomes of various minimally invasive surgical procedures.

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Acknowledgments

The authors would like to thank Ho Kim, BS, Jae Eun Park, BS, and Sol Lee, BS, for their support and assistance with this study.

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Authors and Affiliations

  1. Department of Neurosurgery, Gachon University Gil Medical Center, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea (South Korea)

    Y. Ahn & T. S. Jeong

  2. Department of Radiology, Gachon University Gil Medical Center, Incheon, South Korea

    T. Lim & J. Y. Jeon

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  1. Y. Ahn
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  2. T. S. Jeong
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  4. J. Y. Jeon
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Correspondence to Y. Ahn.

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Funding

This research was funded by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (Grant number HI16C2319).

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Informed consent was obtained from all individual participants included in the study.

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Ahn, Y., Jeong, T.S., Lim, T. et al. Grading system for migrated lumbar disc herniation on sagittal magnetic resonance imaging: an agreement study. Neuroradiology 60, 101–107 (2018). https://doi.org/10.1007/s00234-017-1943-7

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  • DOI: https://doi.org/10.1007/s00234-017-1943-7

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