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The Haleem–Botchu classification: a novel CT-based classification for lumbar foraminal stenosis

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Abstract

Purpose

No clinical CT-based classification system is currently in use for lumbar foraminal stenosis. MRI scanners are not easily available, are expensive and may be contraindicated in an increasing number of patients. This study aimed to propose and evaluate the reproducibility of a novel CT-based classification for lumbar foraminal stenosis.

Materials and methods

The grading was developed as four grades: normal foramen—Grade 0, anteroposterior (AP)/superoinferior (SI) (single plane) fat compression—Grade 1, both AP/SI compression (two planes) without distortion of nerve root—Grade 2 and Grade 2 with distortion of nerve root—Grade 3.

A total of 800 lumbar foramen of a cohort of 100 random patients over the age of 60 who had undergone both CT and MRI scans were reviewed by two radiologists independently to assess agreement of the novel CT classification against the MRI-based grading system of Lee et al. Interobserver(n = 400) and intraobserver agreement(n = 160) was also evaluated. Agreement analysis was performed using the weighted kappa statistic.

Results

A total of 100 patients (M:F = 45:55) with a mean age of 68.5 years (range 60–83 years were included in the study. The duration between CT and MRI scans was 98 days (range 0–540, SD—108). There was good correlation between CT and MRI with kappa scores (k = 0.81) and intraobserver kappa of 0.89 and 0.98 for the two readers.

Conclusion

The novel CT-based classification correlates well with the MRI grading system and can safely and accurately replace it where required.

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Authors and Affiliations

  1. Royal Orthopaedic Hospital, The Woodlands, Bristol Road South, Birmingham, B31 2AP, UK

    S. Haleem, V. Guduri, C. Azzopardi, S. James & R. Botchu

  2. Division of Medical Education, University of Brighton, Brighton, UK

    M. Malik

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  1. S. Haleem
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  2. M. Malik
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  3. V. Guduri
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  4. C. Azzopardi
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  5. S. James
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  6. R. Botchu
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Contributions

SH contributed to original concept, discussed framework, analysed data, wrote and critically reviewed article for final acceptance. MM discussed framework, analysed data, critically reviewed article for final acceptance. VG discussed framework and critically reviewed article for final acceptance. CA analysed scans and data and critically reviewed article for final acceptance. SJ analysed scans and data, critically reviewed article for final acceptance. RB discussed framework, analysed data, wrote and critically reviewed article for final acceptance.

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Correspondence to S. Haleem.

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Haleem, S., Malik, M., Guduri, V. et al. The Haleem–Botchu classification: a novel CT-based classification for lumbar foraminal stenosis. Eur Spine J 30, 865–869 (2021). https://doi.org/10.1007/s00586-020-06656-5

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  • DOI: https://doi.org/10.1007/s00586-020-06656-5

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