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Use of abnormal lumbar disc herniation definitions had high level of validation evidence
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SAN FRANCISCO — Use of a multi-society task force’s descriptive definitions of abnormal lumbar disc morphology demonstrated a high level of agreement between imaging diagnosis and surgical findings, according to data presented at the North American Spine Society Annual Meeting, here.
“This is the first study with gold standard, so it is a very high level 1 evidence of abnormal disc morphology of agreement between imaging and surgery,” Charles H. Cho, MD, MBA, said during his presentation.
Charles H. Cho
The consensus document for image descriptions, which uses MRI as a surgical gold standard, was created in 2001 by multiple national medical societies, including the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology.
In the retrospective study, Cho and colleagues reviewed the medical records of 86 consecutive patients who were in an ongoing prospective trial to evaluate outcomes of single-level lumbar discectomy. The data reviewed included documentation of intraoperative findings and classification of the herniation as protrusion, extrusion or sequestration.
Two blinded readers used preoperative MRI to classify abnormal discs as protrusion, extrusion or sequestration, with discrepancies resolved by a third reader. Intraoperative findings were the diagnostic gold standard, and outcome measures included agreement between MRI classifications of disc herniation with surgical findings.
Among the 82 patients who had operative data, 54 patients had preoperative MRIs available for evaluation. One patient had a final imaging diagnosis discrepancy, which was resolved by the third reader.
The researchers found eight patients had protrusions and 46 patients had extrusion with no sequestration by MRI imaging, whereas 13 patients had protrusion and 40 patients had extrusions in surgery. Overall, two patients had extrusions that also contained sequestrations. One patient had sequestration and no extrusion.
The researchers calculated the total number of discrepancies between imaging and surgery as 16 of the 54 patients with a 70% agreement, according to Cho. — by Kristine Houck, MA, ELS
Reference:
Cho CH. Paper #22. Presented at: North American Spine Society Annual Meeting. Nov. 12-15, 2014; San Francisco.
Disclosure: Cho has no relevant financial disclosures.