Ahn Yong, Kim Ji-Eun, Yoo Byung-Rhae, Jeong Yu-Mi
Department of Neurosurgery, Gachon University Gil Medical Center, Incheon 21565, Korea.
College of Medicine, Gachon University, Incheon 21565, Korea.
J Clin Med. 2022 Mar 22;11(7):1750. doi: 10.3390/jcm11071750.
Understanding the degree of disc migration is essential in order to diagnose, treat, and assess the prognosis of migrated lumbar disc herniation (LDH). Based on anatomical configuration, we developed a simple six-level grading system for migrated lumbar disc herniation. We aimed to evaluate whether the new grading system was reliable and could replace the previous grading system. We selected 101 cases from our database. Two independent raters evaluated the magnetic resonance images using each grading system. Interobserver, intraobserver, and inter-grading system agreements were assessed using kappa statistics. The most common migration pattern was low-grade inferior migration. Interobserver agreements between the two readers showed substantial agreement in the first and second assessments (k = 0.753 and 0.756, respectively). The intraobserver agreement of reader 1 revealed substantial agreement (k = 0.733), while that of reader 2 revealed almost perfect agreement (k = 0.829). The strengths of the agreements of the new grading system were higher than those of the Lee-Kim grading system. The two grading systems agreed almost perfectly for most measurements. The new grading system was reliable and feasible to determine migrated LDH grade. It allowed for a more intuitive, objective measurement and helped select surgical options.
了解椎间盘移位程度对于诊断、治疗和评估移位型腰椎间盘突出症（LDH）的预后至关重要。基于解剖结构，我们为移位型腰椎间盘突出症开发了一种简单的六级分级系统。我们旨在评估新的分级系统是否可靠，以及是否可以取代先前的分级系统。我们从数据库中选取了101例病例。两名独立的评估者使用每种分级系统对磁共振图像进行评估。使用kappa统计量评估观察者间、观察者内和分级系统间的一致性。最常见的移位模式是低级别的向下移位。两位读者之间的观察者间一致性在第一次和第二次评估中显示出高度一致性（分别为k = 0.753和0.756）。读者1的观察者内一致性显示出高度一致性（k = 0.733），而读者2的观察者内一致性显示出几乎完美的一致性（k = 0.829）。新分级系统的一致性强度高于Lee-Kim分级系统。对于大多数测量，两种分级系统几乎完全一致。新的分级系统在确定移位型LDH分级方面是可靠且可行的。它允许进行更直观、客观的测量，并有助于选择手术方案。
