SA Orthopaedic Journal
On-line version ISSN 2309-8309
FLEMING, MA et al. Interrater reliability assessment of pre-reduction MRI features identifying hazardous disc disruption in distractive-flexion cervical spine injuries. SA orthop. j. [online]. 2014, vol.13, n.4, pp. 14-17. ISSN 2309-8309.
AIM: This study assessed the interrater reliability of MRI when radiologists and orthopaedic surgeons assess intervertebral disc injury characteristics in distraction flexion (DF) injuries in the cervical spine. The most reliable MRI features of intervertebral disc injury are identified for future use METHODS: Pre-reduction MRI scans of 110 consecutive DF injuries were reviewed independently by a radiology and an orthopaedic surgical team. All cases were managed at a single tertiary referral unit over a ten-year period. Variables included for assessment were: disc herniation (posterior to the inferior vertebrae or above the level of the superior vertebrae's endplate), disc disruption, posterior longitudinal ligament disruption and disc containment. A double data entry method was used. Cohen's kappa value was used to determine interrater reliability RESULTS: Perfect agreement was never achieved between the two teams. The variables that had the highest interrater agreement were posterior disc prolapse and impression of containment. When disagreement occurred, the radiology team would tend to define the lesions as more severe than the orthopaedic team CONCLUSION: MRI assessment of disc injury characteristics carries moderate to fair interrater reliability at best. We conclude that the treating surgeon should review scan images personally prior to choosing a treatment algorithm, not relying solely on a written report. Posterior herniation and disc containment carry the highest interrater reliability.
Keywords : cervical disc prolapse; MRI interrater reliability; distraction flexion; unifacet; bifacet subluxation.