title: Reliability of the modified Tufts Lumbar Degenerative Disc Classification between neurosurgeons and neuroradiologists.
abstract: Cross-specialty inter-rater reliability has not been explicitly reported for imaging characteristics that are thought to be important in lumbar intervertebral disc degeneration. Sufficient cross-specialty reliability is an essential consideration if radiographic stratification of symptomatic patients to specific treatment modalities is to ever be realized. Therefore the purpose of this study was to directly compare the assessment of such characteristics between neurosurgeons and neuroradiologists. Sixty consecutive patients with a diagnosis of lumbago and appropriate imaging were selected for inclusion. Lumbar MRI were evaluated using the Tufts Degenerative Disc Classification by two neurosurgeons and two neuroradiologists. Inter-rater reliability was assessed using Cohen's κ values both within and between specialties. A sensitivity analysis was performed for a modified grading system, which excluded high intensity zones (HIZ), due to poor cross-specialty inter-rater reliability of HIZ between specialties. The reliability of HIZ between neurosurgeons and neuroradiologists was fair in two of the four cross-specialty comparisons in this study (neurosurgeon 1 versus both radiologists κ=0.364 and κ=0.290). Removing HIZ from the classification improved inter-rater reliability for all comparisons within and between specialties (0.465⩽κ⩽0.576). In addition, intra-rater reliability remained in the moderate to substantial range (0.523⩽κ⩽0.649). Given our findings and corroboration with previous studies, identification of HIZ seems to have a markedly variable reliability. Thus we recommend modification of the original Tufts Degenerative Disc Classification by removing HIZ in order to make the overall grade provided by this classification more reproducible when scored by practitioners of different training backgrounds.
authors.affiliation: Department of Neurosurgery, Tufts Medical Center, 800 Washington Street #178, Proger 7, Boston, MA 02111, USA; Department of Neurosurgery, Tufts University School of Medicine, Boston, MA, USA.
authors.forename: Shane M
authors.initials: SM
authors.lastname: Burke
authors.affiliation: Department of Neurosurgery, Tufts Medical Center, 800 Washington Street #178, Proger 7, Boston, MA 02111, USA; Department of Neurosurgery, Tufts University School of Medicine, Boston, MA, USA.
authors.forename: Steven W
authors.initials: SW
authors.lastname: Hwang
authors.affiliation: Department of Radiology, Tufts Medical Center, Boston, MA, USA; Department of Radiology, Tufts University School of Medicine, Boston, MA, USA.
authors.forename: William A
authors.initials: WA
authors.lastname: Mehan
authors.affiliation: Department of Radiology, Tufts Medical Center, Boston, MA, USA; Department of Radiology, Tufts University School of Medicine, Boston, MA, USA.
authors.forename: Harprit S
authors.initials: HS
authors.lastname: Bedi
authors.affiliation: Department of Neurosurgery, Tufts Medical Center, 800 Washington Street #178, Proger 7, Boston, MA 02111, USA; Department of Neurosurgery, Tufts University School of Medicine, Boston, MA, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Ogbuji
authors.affiliation: Department of Neurosurgery, Tufts Medical Center, 800 Washington Street #178, Proger 7, Boston, MA 02111, USA; Department of Neurosurgery, Tufts University School of Medicine, Boston, MA, USA. Electronic address: rriesenburger@tuftsmedicalcenter.org.
authors.forename: Ron I
authors.initials: RI
authors.lastname: Riesenburger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000145:classification* / Q000000981:diagnostic imaging / Q000601:surgery; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging* / Q000601:surgery; D008161:Lumbosacral Region; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D000069471:Neurosurgeons; D015588:Observer Variation; D000072177:Radiologists; D055815:Young Adult
keywords: Classification; Intervertebral disc degeneration; Lumbar vertebrae; Reproducibility of results; Spine