An Independent Agreement Study of Modified Pfirrmann Grading System for Cervical Inter-vertebral Disc Degeneration in Cervical Spondylotic Myelopathy

Abstract Background Neck pain, sensory disturbance and motor dysfunction in most patients suffered cervical spondylotic myelopathy (CSM). For CSM surgery, it is necessary to evaluate preoperative inter-vertebral disc degeneration (IDD) which determines whether to adopt fusion strategy, and postoperative IDD which is one of the main reasons for reoperation. Modified Pfirrmann grading system is commonly used to evaluate IDD. The objective of this study is to evaluate its reliability and reproducibility on cervical IDD in CSM patients, and to explore its clinical application value. Methods/Design: All 165 patients with CSM were enrolled. 6 physicians (3 spine surgeons and 3 radiologists) who have certain clinical experience were selected. They graded cervical inter-vertebral disc according to modified Pfirrmann grading system, we used intra-class correlation coefficient (ICC) and weighted kappa (wκ) to assess the inter- and intra-observer agreement. After 12 weeks, we repeated the analysis. Results The inter-observer reliability of modified Pfirrmann grading system was excellent with ICC value of 0.76 and near perfect with wκ value of 0.82. The intra-observer reproducibility of modified Pfirrmann grading system was excellent with ICC values ranging from 0.80–0.91, and near perfect with wκ values ranging from 0.83–0.92. Conclusion Modified Pfirrmann grading system has excellent inter-observer reliability and intra-observer reproducibility on cervical IDD in CSM. In addition, it indicates a good appliance among spine surgeons and radiologists, clinical and radiological studies applying it should be deemed accurate. Thus, modified Pfirrmann grading system can be widely used as an appropriate instrument in clinical care.

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An independent agreement study of modified Pfirrmann grading system for cervical inter-vertebral disc degeneration in cervical spondylotic myelopathy

British Journal of Neurosurgery ◽

10.1080/02688697.2020.1861431 ◽

2020 ◽

pp. 1-5

Author(s):

Chongqing Xu ◽

Mengchen Yin ◽

Wen Mo

Keyword(s):

Disc Degeneration ◽

Cervical Spondylotic Myelopathy ◽

Grading System ◽

Vertebral Disc ◽

Agreement Study

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Reliability of Hallux Rigidus Radiographic Grading System

Kansas Journal of Medicine ◽

10.17161/kjm.v8i4.11533 ◽

2015 ◽

Vol 8 (4) ◽

pp. 125-134

Author(s):

Ryan C. Pate ◽

John W. Fanning ◽

Naomi N. Shields ◽

Alexander C.M. Chong

Keyword(s):

Weight Bearing ◽

Hallux Rigidus ◽

Observer Agreement ◽

Grading System ◽

Foot And Ankle ◽

Substantial Agreement ◽

Radiographic Images ◽

Observer Reliability ◽

Grade 3 ◽

Radiographic Grading

Introduction. The purpose of this study was to determine the inter- and intra-observer reliability of a clinical radiographic scale for hallux rigidus. Methods. A total of 80 patients were retrospectively selected from the patient population of two foot and ankle orthopaedic surgeons. Each corresponding series of radiographic images (weight-bearing anteroposterior, weight-bearing lateral, and oblique of the foot) was randomized and evaluated. Re-randomization was performed and the corresponding radiograph images re-numbered. Four orthopaedic foot and ankle surgeons graded each patient, and each rater reclassified the re-randomized radiographic images three weeks later. Results. Sixty-one out of 80 patients (76%) were included in this study. For intra-observer reliability, most of the raters showed “excellent” agreement except one rater had a “substantial” agreement. For inter-observer reliability, only 14 out of 61 cases (23%) showed total agreement between the eight readings from the four surgeons, and 11 out of the 14 cases (79%) were grade 3 hallux rigidus. One of the raters had a tendency to grade at a higher grade resulting in poorer agreement. If this rater was excluded, the results demonstrated a “substantial” agreement by using this classification. Conclusion. The hallux rigidus radiographic grading system should be used with caution. Although there is an “excellent” level of intra-observer agreement, there is only “moderate” to “substantial” level of inter-observer reliability.

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Comparison of SDSG and CARDS classifications for L5/S1 lumbar degenerative spondylolisthesis: An independent inter- and intra-observer agreement study

10.21203/rs.3.rs-107455/v1 ◽

2020 ◽

Author(s):

Chongqing Xu ◽

Mengchen Yin ◽

Wen Mo

Keyword(s):

Treatment Plan ◽

Degenerative Spondylolisthesis ◽

Observer Agreement ◽

Common Disease ◽

Low Back ◽

K Value ◽

Observer Reliability ◽

Lumbar Degenerative Spondylolisthesis ◽

Radicular Symptoms ◽

Agreement Study

Abstract Background Lumbar degenerative spondylolisthesis (DS) has been a common disease that make increasing patients suffer from different degrees of low back pain and radicular symptoms. SDSG and CARDS systems are commonly used to classify the disease, and help to make a more detailed treatment plan. The objective of this study is to evaluate the reliability and reproducibility of SDSG and CARDS classifications, and to explore their clinical application value. Methods/Design: All 117 patients with L5/S1 lumbar DS were enrolled. 5 spine surgeons who have certain clinical experience were selected. They determined the classification according to S SDSG and CARDS systems, we used kappa (K) value to check the coefficient consistency for multi-factor and assess the inter- and intra-observer agreement. After 12 weeks, we repeated the analysis. Results The inter-observer reliability and intra-observer reproducibility of SDSG system were substantial with K values of 0.704 and 0.861, while those of CARDS system were substantial with values of 0.620 and 0.878. Conclusion SDSG system has better inter-observer reliability in comparison with CARDS system, and though CARDS system is more intuitive and simpler, it is more likely to produce deviations when using it. Since both SDSG and CARDS systems show substantial agreement and have great significance in surgical strategy of L5/S1 lumbar DS, they can be widely used in clinical practice.

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An endoscopic grading system for vocal process granuloma

The Journal of Laryngology & Otology ◽

10.1017/s0022215108001722 ◽

2008 ◽

Vol 122 (10) ◽

pp. 1092-1095 ◽

Cited By ~ 18

Author(s):

D G Farwell ◽

P C Belafsky ◽

C J Rees

Keyword(s):

Disease Severity ◽

Treatment Efficacy ◽

Observer Agreement ◽

Grading System ◽

Test Statistic ◽

Observer Reliability ◽

Vocal Process ◽

Image Library ◽

Grade One

AbstractBackground:A reliable grading system allows the clinician to classify disease severity, monitor progress and evaluate treatment efficacy. There is no currently accepted grading system for vocal process granuloma of the larynx.Aim:To evaluate the reliability of a new grading system for vocal process granuloma.Methods:All vocal process granuloma images from a digital laryngeal image library were abstracted. Granulomas were graded on a one to four system, as follows: grade one, sessile, non-ulcerative granuloma limited to vocal process; grade two, pedunculated or ulcerated granuloma limited to vocal process; grade three, granuloma extending past vocal process but not crossing midline of airway in fully abducted position; and grade four, granuloma extending past vocal process and past the midline of the airway in the fully abducted position. The granulomas were additionally graded A if unilateral and B if bilateral. Two laryngologists and two otolaryngology residents rated the granulomas on two separate occasions. Intra- and inter-observer reliability was evaluated with the kappa (κ) test statistic.Results:Thirty-five vocal process granulomas were identified. The percentage intra-observer agreement for the two laryngologists was 97 and 100 per cent (κ = 0.94 and 1.00, respectively). The percentage inter-observer agreement between the two laryngologists was 91 per cent (κ = 0.83). The percentage intra-observer agreement for the two residents was 89 and 91 per cent (κ = 0.83 and 0.77, respectively). The percentage inter-observer agreement between the two residents was 83 per cent (κ = 0.67).Conclusions:The proposed grading system for vocal process granuloma displayed excellent intra- and inter-observer reliability among residents and experienced laryngologists.

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Comparison of SDSG and CARDS classifications for L5/S1 lumbar degenerative spondylolisthesis: an independent inter- and intra-observer agreement study

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02539-7 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Zhengwang Sun ◽

Chongqing Xu ◽

Mengchen Yin ◽

Wangjun Yan

Keyword(s):

Treatment Plan ◽

Degenerative Spondylolisthesis ◽

Observer Agreement ◽

Common Disease ◽

Low Back ◽

K Value ◽

Observer Reliability ◽

Lumbar Degenerative Spondylolisthesis ◽

Radicular Symptoms ◽

Agreement Study

Abstract Background Lumbar degenerative spondylolisthesis (DS) has been a common disease that makes increasing patients to suffer from different degrees of low back pain and radicular symptoms. The Spinal Deformity Study Group (SDSG) and the Clinical and Radiographic Degenerative Spondylolisthesis (CARDS) systems are commonly used to classify the disease, and help to make a more detailed treatment plan. The objective of this study is to compare the reliability and reproducibility of SDSG and CARDS classifications, and to explore their clinical application value. Methods/design All 117 patients with L5/S1 lumbar DS were enrolled. Five experienced spine surgeons were selected to assess DS with SDSG and CARDS systems. Kappa (K) value was used to check the coefficient consistency for multi-factor and assess the inter- and intra-observer agreement. After 12 weeks, the analysis was repeated. Results The inter-observer reliability and intra-observer reproducibility of SDSG system were substantial with K values of 0.704 and 0.861, while those of CARDS system were substantial with values of 0.620 and 0.878. Conclusion SDSG system had better inter-observer reliability in comparison with CARDS system, and though CARDS system is more intuitive and simpler, it is more likely to produce deviations when using it. Both SDSG and CARDS systems show substantial agreement and have great significance in surgical strategy of L5/S1 lumbar DS, they can be widely used in clinical practice.

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Validity and interobserver agreement of a new radiographic grading system for intervertebral disc degeneration: Part III. Thoracic spine

European Spine Journal ◽

10.1007/s00586-021-06970-6 ◽

2021 ◽

Author(s):

Christian Liebsch ◽

Youping Tao ◽

Annette Kienle ◽

Hans-Joachim Wilke

Keyword(s):

Intervertebral Disc ◽

Disc Degeneration ◽

Intervertebral Disc Degeneration ◽

Interobserver Agreement ◽

Weighted Kappa ◽

Intervertebral Discs ◽

Height Loss ◽

Grading System ◽

Perfect Agreement ◽

Radiographic Grading

Abstract Purpose The aim of this study was to assess the validity and objectivity of a new quantitative radiographic grading system for thoracic intervertebral disc degeneration. Methods The new grading system involves the measurement variables “Height loss” and “Osteophyte formation”, which are determined from lateral radiographs, resulting in the “Overall degree of degeneration” on a four-point scale from 0 (no degeneration) to 3 (severe degeneration). Validation was performed by comparing the radiographic degrees of degeneration of 54 human intervertebral discs to the respective macroscopic degrees, which were defined as the “real” degrees of degeneration. Interobserver agreement was examined using radiographs of 135 human thoracic intervertebral discs. Agreement was quantified by means of quadratically weighted Kappa coefficients with 95% confidence limits (CL). Results Validation revealed almost perfect agreement between the radiographic and the macroscopic overall degrees of degeneration (Kappa 0.968, CL 0.944–0.991), while the macroscopic grades tended to be underestimated in low degeneration grades. Radiographic grading of two independent observers also exhibited almost perfect agreement (Kappa 0.883, CL 0.824–0.941) as well as tendencies towards rater-dependent differences in low degeneration grades. Conclusion The new quantitative radiographic grading scheme represents a valid, reliable, and almost objective method for assessing the degree of degeneration of individual thoracic intervertebral discs. Potential effects of interindividual variations and the radiographic superimposition of anatomical structures represent a limitation of this method should be taken into account when using the grading system for clinical and experimental purposes, especially with regard to specific morphological as well as patient- and donor-specific characteristics.

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Reliability of the modified lateral pillar classification for Legg Calvé Perthes disease performed by a large group of international paediatric orthopaedic surgeons

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.14.200055 ◽

2020 ◽

Vol 14 (6) ◽

pp. 529-536

Author(s):

Jennifer C. Laine ◽

Susan A. Novotny ◽

Stefan Huhnstock ◽

Andrew J. Ries ◽

John E. Tis ◽

...

Keyword(s):

Gold Standard ◽

Weighted Kappa ◽

Observer Agreement ◽

Perthes Disease ◽

Kappa Statistics ◽

Level Of Evidence ◽

Lateral Pillar ◽

Orthopaedic Surgeons ◽

Observer Reliability ◽

Paediatric Orthopaedic

Purpose The modified lateral pillar classification (mLPC) is used for prognostication in the fragmentation stage of Legg Calvé Perthes disease. Previous reliability assessments of mLPC range from fair to good agreement when evaluated by a small number of observers with pre-selected radiographs. The purpose of this study was to determine the inter-observer and intra-observer reliability of mLPC performed by a group of international paediatric orthopaedic surgeons. Surgeons self-selected the radiograph for mLPC assessment, as would be done clinically. Methods In total, 40 Perthes cases with serial radiographs were selected. For each case, 26 surgeons independently selected a radiograph and assigned mLPC and 21 raters re-evaluated the same 40 cases to establish intra-observer reliability. Rater performance was determined through surgeon consensus using the mode mLPC as ‘gold standard’. Inter-observer and intra-observer reliability data were analysed using weighted kappa statistics. Results The weighted kappa for inter-observer correlation for mLPC was 0.64 (95% confidence interval: 0.55 to 0.74) and was 0.82 (range: 0.35 to 0.99) for intra-observer correlation. Individual surgeon’s overall performance varied from 48% to 88% agreement. Surgeon mLPC performance was not influenced by years of experience (p = 0.51). Radiograph selection did not influence gold standard assignment of mLPC. There was greater agreement on cases of mild B hips and severe C hips. Conclusions mLPC has low good inter-observer agreement when performed by a large number of surgeons with varied experience. Surgeons frequently chose different radiographs, with no impact on mLPC agreement. Further refinement is needed to help differentiate hips on the border of group B and C. Level of evidence III

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An Independent Inter- and Intra-Observer Agreement Assessment of Yeom Classification for Bone Cement Leakage Following Vertebroplasty/Kyphoplasty

10.21203/rs.3.rs-107454/v1 ◽

2020 ◽

Author(s):

Chongqing Xu ◽

Mengchen Yin ◽

Wen Mo

Keyword(s):

Bone Cement ◽

Clinical Care ◽

Cement Leakage ◽

Early Observation ◽

Observer Agreement ◽

Vertebral Compression Fractures ◽

Osteoporotic Vertebral Compression Fractures ◽

K Value ◽

Observer Reliability ◽

Agreement Assessment

Abstract Background: The clinical efficacy of vertebroplasty and kyphoplasty treating osteoporotic vertebral compression fractures (OVCF) has been widely recognized in recent years. However, there are also inevitable complications, first and foremost is bone cement leakage (BCL). Yeom classification is commonly used to evaluate BCL. The objective of this study is to assess its reliability and reproducibility, and to explore its clinical application value.Methods/Design: All 58 patients with BCL following vertebroplasty / kyphoplasty were involved. 6 spine surgeons were selected to be evaluators as they were unaware of the identity of the patients and the treatment they received. They classified BCL according to Yeom system, we used kappa (K) to assess the inter- and intra-observer agreement. After 12 weeks, we repeated the analysis.Results: The inter-observer reliability of Yeom classification was substantial with K value of 0.71 (1st assessment) and 0.73 (2nd assessment). The intra-observer reproducibility of Yeom classification was near perfect with K value of 0.88.Conclusion: Yeom classification system has substantial inter-observer reliability and near perfect intra-observer reproducibility in BCL following vertebroplasty / kyphoplasty, which can be widely used in clinical care as an appropriate instrument for early observation, mechanism and severity cognition, and prognosis predicting of BCL. Besides, the adding of type M (the mixed type) may improve the classification.

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Comparison of SDSG and CARDS Classifications for L5/S1 Lumbar Degenerative Spondylolisthesis: an Independent Inter- and Intra-observer Agreement Study

10.21203/rs.3.rs-146664/v1 ◽

2021 ◽

Author(s):

Zhengwang Sun ◽

Chongqing Xu ◽

Mengchen Yin ◽

Wangjun Yan

Keyword(s):

Treatment Plan ◽

Degenerative Spondylolisthesis ◽

Observer Agreement ◽

Common Disease ◽

Low Back ◽

K Value ◽

Observer Reliability ◽

Lumbar Degenerative Spondylolisthesis ◽

Radicular Symptoms ◽

Agreement Study

Abstract Background: Lumbar degenerative spondylolisthesis (DS) has been a common disease that make increasing patients suffer from different degrees of low back pain and radicular symptoms. SDSG and CARDS systems are commonly used to classify the disease, and help to make a more detailed treatment plan. The objective of this study is to evaluate the reliability and reproducibility of SDSG and CARDS classifications, and to explore their clinical application value.Methods/Design: All 117 patients with L5/S1 lumbar DS were enrolled. 5 spine surgeons who have certain clinical experience were selected. They determined the classification according to S SDSG and CARDS systems, we used kappa (K) value to check the coefficient consistency for multi-factor and assess the inter- and intra-observer agreement. After 12 weeks, we repeated the analysis.Results: The inter-observer reliability and intra-observer reproducibility of SDSG system were substantial with K values of 0.704 and 0.861, while those of CARDS system were substantial with values of 0.620 and 0.878.Conclusion: SDSG system has better inter-observer reliability in comparison with CARDS system, and though CARDS system is more intuitive and simpler, it is more likely to produce deviations when using it. Since both SDSG and CARDS systems show substantial agreement and have great significance in surgical strategy of L5/S1 lumbar DS, they can be widely used in clinical practice.

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