Interobserver agreement in fusion status assessment after instrumental desis of the lower lumbar spine using 64-slice multidetector computed tomography: impact of observer experience
Borislav Laoutliev, Inger Havsteen, Birthe Højlund Bech, Eva Narvestad, Hanne Christensen, Anders Christensen
October 2012, Volume 21, Issue 10, pp 2085 - 2090 Original Article Read Full Article 10.1007/s00586-012-2192-4
First Online: 19 February 2012
Purpose
Persistent lower back pain after instrumental posterolateral desis may arise from incomplete fusion. We investigate the impact of experience on interobserver agreement in fusion estimation.
Methods
Four independent observers, two residents and two musculoskeletal radiologists, reviewed dedicated lumbar 64-MDCT scans and scored vertebral levels 1–5 after Glassman’s grades, 1: solid bilateral fusion, 2: solid unilateral fusion, 3: partial bilateral fusion, 4: partial unilateral fusion, 5: non-fusion. We investigated two simplifying dichotomizations, solid bilateral fusion (Glassman 1) versus all others and uni- or bilateral fusion (Glassman 1–2) versus partial or non-fusion.
Results
Thirty-six patients with 61 operated lumbar levels were included. Interobserver agreement rates for four observers using Glassman’s system were fair (kappa 0.32), either dichotomization showed moderate agreement (kappa 0.53 and 0.59). Observer pairs had comparable prevalence adjusted interobserver agreement rates (residents: PABAK 0.67 and 0.54; consultants: PABAK 0.57 and 0.71).
Conclusions
Difference in observer experience seems of minor impact.
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