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. 2022 Mar 22;11(7):1750.
doi: 10.3390/jcm11071750.

A New Grading System for Migrated Lumbar Disc Herniation on Sagittal Magnetic Resonance Imaging: An Agreement Study

Yong Ahn  1 , Ji-Eun Kim  2 , Byung-Rhae Yoo  1 , Yu-Mi Jeong  3
Affiliations

A New Grading System for Migrated Lumbar Disc Herniation on Sagittal Magnetic Resonance Imaging: An Agreement Study

Yong Ahn et al. J Clin Med. .

Abstract

Understanding the degree of disc migration is essential in order to diagnose, treat, and assess the prognosis of migrated lumbar disc herniation (LDH). Based on anatomical configuration, we developed a simple six-level grading system for migrated lumbar disc herniation. We aimed to evaluate whether the new grading system was reliable and could replace the previous grading system. We selected 101 cases from our database. Two independent raters evaluated the magnetic resonance images using each grading system. Interobserver, intraobserver, and inter-grading system agreements were assessed using kappa statistics. The most common migration pattern was low-grade inferior migration. Interobserver agreements between the two readers showed substantial agreement in the first and second assessments (k = 0.753 and 0.756, respectively). The intraobserver agreement of reader 1 revealed substantial agreement (k = 0.733), while that of reader 2 revealed almost perfect agreement (k = 0.829). The strengths of the agreements of the new grading system were higher than those of the Lee-Kim grading system. The two grading systems agreed almost perfectly for most measurements. The new grading system was reliable and feasible to determine migrated LDH grade. It allowed for a more intuitive, objective measurement and helped select surgical options.

Keywords: agreement; grade; lumbar; magnetic resonance imaging; migrated disc herniation.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Schematic illustration of the six migrated lumbar disc grades of the new grading system in the sagittal plane. Note the degree of disc migrations; very high (VH), high (H), and low (L).
Figure 2
Figure 2
Grade of migrated lumbar disc herniation on a sagittal MRI image (asterisk). (A) Grade 1, superior very high grade. (B) Grade 2, superior high grade. (C) Grade 3, superior low grade. (D) Grade 4, inferior low grade. (E) Grade 5, inferior high grade. (F) Grade 6, inferior very high grade.
Figure 3
Figure 3
The direction of disc migration in the sagittal plane stratified by the level of disc herniation. Note the tendency for more superior migration in the upper lumbar disc level and more inferior migration in the lower (p < 0.05).
Figure 4
Figure 4
The direction of disc migration in the sagittal plane stratified by age. Note the tendencies of more superior migration in the patients older than 50 years of age and more inferior migration in the patients younger than 50 years of age (p = 0.0671).
See this image and copyright information in PMC

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