Riesenburger Ron I, Safain Mina G, Ogbuji Richard, Hayes Jackson, Hwang Steven W
Department of Neurosurgery, Tufts Medical Center, 800 Washington Street #178, Proger 7, Boston, MA 02111, USA; Tufts University School of Medicine, Boston, MA, USA.
Department of Neurosurgery, Tufts Medical Center, 800 Washington Street #178, Proger 7, Boston, MA 02111, USA; Tufts University School of Medicine, Boston, MA, USA.
J Clin Neurosci. 2015 Feb;22(2):346-51. doi: 10.1016/j.jocn.2014.05.052. Epub 2014 Oct 22.
The Pfirrmann and modified Pfirrmann grading systems are currently used to classify lumbar disc degeneration. These systems, however, do not incorporate variables that have been associated with lumbar disc degeneration, including Modic changes, a high intensity zone, and a significant reduction in disc height. A system that incorporates these variables that is easy to apply may be useful for research and clinical purposes. A grading system was developed that incorporates disc structure and brightness, presence or absence of Modic changes, presence or absence of a high intensity zone, and reduction in disc height (disc height less than 5mm). MRI of 300 lumbar discs in 60 patients were analyzed twice by two neurosurgeons. Intra and inter-observer reliabilities were assessed by calculating Cohen's κ values. There were 156 grade zero ("normal"), 50 grade one, 57 grade two, 26 grade three, 10 grade four, and one grade five ("worst") discs. Inter-observer reliability was substantial (κ = 0.66 to 0.77) for disc brightness/structure, Modic changes, and disc height. Inter-observer reliability was moderate (κ = 0.41) for high intensity zone. Intra-observer reliability was moderate to excellent (κ = 0.53 to 0.94) in all categories. Agreement on the total grade between reviewers occurred 71% of the time and a difference of one grade occurred in an additional 25% of cases. Lumbar disc degeneration can be graded reliably by this novel system. The advantage of this system is that it incorporates disc brightness/structure, Modic changes, high intensity zone, and a rigid definition of loss of disc height. This system might be useful in research studies evaluating disc degeneration. Further studies are required to demonstrate possible clinical utility in predicting outcomes after spinal treatments such as fusion.
目前，Pfirrmann分级系统和改良的Pfirrmann分级系统用于对腰椎间盘退变进行分类。然而，这些系统并未纳入与腰椎间盘退变相关的变量，包括Modic改变、高信号区以及椎间盘高度的显著降低。一个易于应用且纳入这些变量的系统可能对研究和临床目的有用。开发了一种分级系统，该系统纳入了椎间盘结构和亮度、Modic改变的有无、高信号区的有无以及椎间盘高度的降低（椎间盘高度小于5mm）。60例患者的300个腰椎间盘的MRI由两名神经外科医生进行了两次分析。通过计算Cohen's κ值评估观察者间和观察者内的可靠性。有156个零级（“正常”）椎间盘、50个一级椎间盘、57个二级椎间盘、26个三级椎间盘、10个四级椎间盘和1个五级（“最差”）椎间盘。观察者间对椎间盘亮度/结构、Modic改变和椎间盘高度的可靠性较高（κ = 0.66至0.77）。观察者间对高信号区的可靠性为中等（κ = 0.41）。观察者内的可靠性在所有类别中为中等至优秀（κ = 0.53至0.94）。 reviewers之间对总分级的一致性在71%的情况下出现，另外25%的病例中分级相差一级。这种新系统可以可靠地对腰椎间盘退变进行分级。该系统的优点是它纳入了椎间盘亮度/结构、Modic改变、高信号区以及椎间盘高度丢失的严格定义。该系统可能在评估椎间盘退变的研究中有用。需要进一步的研究来证明其在预测脊柱治疗（如融合）后结果方面的可能临床效用。
