Validity and interobserver agreement of a new radiographic grading system for intervertebral disc degeneration: Part I. Lumbar spine
Validity and interobserver agreement of a new radiographic grading system for intervertebral disc degeneration: Part I. Lumbar spine
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DOI：
10.1007/s00586-005-1029-9
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发表时间：
2006-06-01
影响因子：
2.8
通讯作者：
Kettler, Annette
中科院分区：
文献类型：
--
作者：
Wilke, Hans-Joachim;Rohlmann, Friederike;Kettler, Annette
文献中描述了许多不同的椎间盘退变放射学分级系统。然而，其中只有少数经过了观察者间一致性测试，而没有进行有效性测试。此外，它们大多是基于主观的术语。因此，本研究的目的是将这些系统合并为一个新的系统，其中所有主观术语都被更客观的术语所取代，并测试这个新系统的有效性和观察者之间的一致性。由于腰椎和颈椎椎间盘需要不同的分级，本研究分为第一部分腰椎和第二部分颈椎。新的x线评分系统包括三个变量“高度损失”、“骨赘形成”和“弥漫性硬化症”。在侧位和后前方x线片上，这三个变量首先必须单独分级。然后，“总体退化程度”按4分制从0（无退化）到3（严重退化）进行分配。为了验证，将44个腰椎间盘的x线退变程度与各自的宏观退变程度进行比较，后者被定义为“真实”退变程度。使用84个腰椎间盘的x线片确定具有不同经验水平的观察者之间的一致性。一致性采用二次加权Kappa系数（Kappa）量化，95%置信限（95% CL）。新的x线影像分级系统的验证显示，x线影像与“真实的”宏观总体退变程度之间有很大的一致性（Kappa=0.714, 95% CL: 0.587-0.841）。然而，放射学分级往往比“真实”分级略低。对于所有三个变量和总体退化程度，观察者之间的一致性是实质性的（Kappa=0.787, 95% CL: 0.702-0.872）。然而，没有经验的观察者倾向于比有经验的观察者分配更低的退化程度。总之，我们认为新的放射学分级系统是一种几乎客观、有效和可靠的量化单个腰椎间盘退变程度的工具。然而，用户应该始终记住，退化的“真实”程度往往被低估，并且具有不同经验水平的观察者的评级之间的细微差异必须得到预期。
Many different radiographic grading systems for disc degeneration are described in literature. However, only a few of them are tested for interobserver agreement and none for validity. Furthermore, most of them are based on a subjective terminology. The aim of this study, therefore, is to combine these systems to a new one in which all subjective terms are replaced by more objective ones and to test this new system for validity and interobserver agreement. Since lumbar and cervical discs need to be graded differently, this study was divided into the present Part I for the lumbar and a Part II for the cervical spine. The new radiographic grading system covers the three variables "Height Loss", "Osteophyte Formation" and "Diffuse Sclerosis". On lateral and postero-anterior radiographs, each of these three variables first has to be graded individually. Then, the "Overall Degree of Degeneration" is assigned on a four-point scale from 0 (no degeneration) to 3 (severe degeneration). For validation, the radiographic degrees of degeneration of 44 lumbar discs were compared to the respective macroscopic ones, which were defined as "real" degrees of degeneration. The agreement between observers with different levels of experience was determined using the radiographs of 84 lumbar discs. Agreement was quantified using quadratic weighted Kappa coefficients (Kappa) with 95% confidence limits (95% CL). The validation of the new radiographic grading system revealed a substantial agreement between the radiographic and the "real" macroscopic overall degree of degeneration (Kappa=0.714, 95% CL: 0.587-0.841). The radiographic grades, however, tended to be slightly lower than the "real" ones. The interobserver agreement was substantial for all the three variables and for the overall degree of degeneration (Kappa=0.787, 95% CL: 0.702-0.872). However, the inexperienced observer tended to assign slightly lower degrees of degeneration than the experienced one. In conclusion, we believe that the new radiographic grading system is an almost objective, valid and reliable tool to quantify the degree of degeneration of individual lumbar intervertebral discs. However, the user should always remember that the "real" degree of degeneration tends to be underestimated and that slight differences between the ratings of observers with different levels of experience have to be expected.