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. 2020 Jan;43(1):43-49.
doi: 10.1016/j.jmpt.2018.11.027. Epub 2020 Feb 17.

Reliability of Human Lumbar Facet Joint Degeneration Severity Assessed by Magnetic Resonance Imaging

Joshua W Little  1 , Thomas Grieve  2 , Joseph Cantu  3 , William C Bogar  4 , Rudy Heiser  4 , Heather Miley  4 , Gregory D Cramer  3
Affiliations

Reliability of Human Lumbar Facet Joint Degeneration Severity Assessed by Magnetic Resonance Imaging

Joshua W Little et al. J Manipulative Physiol Ther. 2020 Jan.

Abstract

Objective: The purpose of this study was to determine the reliability of the assessment of lumbar facet joint degeneration severity by analyzing degeneration subscales using magnetic resonance imaging (MRI) in human participants.

Methods: The reliability of articular cartilage degeneration, subchondral bone sclerosis, and osteophyte formation subscales of lumbar facet joint degeneration severity was assessed in MRI images from n = 10 human participants. Each scale was applied to n = 20 lumbar facet joints (L4/5 level). Three examiners were trained. A first assessment of MRI images was provided by the examiners followed by a second assessment 30 days later. Intraobserver and interobserver reliability were determined using percent agreement, the weighted kappa coefficient κw for paired comparisons, and the overall weighted kappa κo. The minimum threshold for reliability was set at moderate levels of agreement, κw > 0.40, based upon previous recommendations.

Results: The articular cartilage subscale had acceptable intraobserver (κo = 0.51) and interobserver (κo = 0.41) reliability. Scales for subchondral bone sclerosis (intraobserver κo = 0.28; interobserver κo = 0.10) and osteophyte formation (intraobserver κo = 0.26; interobserver κo = 0.20) did not achieve acceptable reliability.

Conclusion: Of the 3 subcategories of lumbar facet joint degeneration, only articular cartilage degeneration demonstrated acceptable reliability. Subscales of lumbar facet joint degeneration should be considered independently for reliability before combining subscales for a global degeneration score. Owing to the inherent difficulty of assessing lumbar facet joint degeneration, the use of multiple examiners independently assessing degeneration with reliable scales and then coming to a consensus score upon any disagreements is recommended for future clinical studies.

Keywords: Diagnostic Imaging; Facet Joint; Lumbar Spine; Magnetic Resonance Imaging; Osteoarthritis; Reliability; Zygapophyseal Joint.

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Figures

Figure 1.
Figure 1.. Examples of grades of articular cartilage degeneration (C).
A: Grade 1: uniform, thick cartilage covering the entire “normal” articular surfaces (arrow). B: Grade 2: cartilage covering the entire articular surfaces with irregular regions of erosion (arrows). C: Grade 3: incomplete cartilage coverage of the articular surface, with erosion leaving bone exposed to the joint (arrows). D: Grade 4: cartilage is generally absent from the articular surfaces, except for trace amounts; joint space decreased (arrow).
See this image and copyright information in PMC

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