Reliability of a Novel Classification System for Thoracic Disc Herniations.

Journal

Spine

ISSN: 1528-1159

Titre abrégé: Spine (Phila Pa 1976)

Pays: United States

ID NLM: 7610646

Informations de publication

Date de publication:
01 May 2023

Historique:

received: 27 07 2022

accepted: 14 11 2022

pubmed: 3 5 2023

medline: 3 5 2023

entrez: 3 5 2023

Statut: aheadofprint

Résumé

Cross-sectional survey. To assess the reliability of a proposed novel classification system for thoracic disc herniations (TDHs). TDHs are complex entities varying substantially in many factors, including size, location, and calcification. To date, no comprehensive system exists to categorize these lesions. Our proposed system classifies 5 types of TDHs using anatomical and clinical characteristics, with subtypes for calcification. Type 0 herniations are small (≤40% of spinal canal) TDHs without significant spinal cord or nerve root effacement; type 1 are small and paracentral; type 2 are small and central; type 3 are giant (>40% of spinal canal) and paracentral; and type 4 are giant and central. Patients with types 1-4 TDHs have correlative clinical and radiographic evidence of spinal cord compression. Twenty-one US spine surgeons with substantial TDH experience rated 10 illustrative cases to determine the system's reliability. Interobserver and intraobserver reliability were determined using the Fleiss kappa coefficient. Surgeons were also surveyed to obtain consensus on surgical approaches for the various TDH types. High agreement was found for the classification system, with 80% (range 62-95%) overall agreement and high interrater and intrarater reliability (kappa 0.604 [moderate to substantial agreement] and kappa 0.630 [substantial agreement], respectively). All surgeons reported nonoperative management of type 0 TDHs. For type 1 TDHs, most respondents (71%) preferred posterior approaches. For type 2 TDHs, responses were roughly equivalent for anterolateral and posterior options. For types 3 and 4 TDHs, most respondents (72% and 68%, respectively) preferred anterolateral approaches. This novel classification system can be used to reliably categorize TDHs, standardize description, and potentially guide the selection of surgical approach. Validation of this system with regard to treatment and clinical outcomes represent lines of future study.

Sections du résumé

STUDY DESIGN METHODS

Cross-sectional survey.

OBJECTIVE OBJECTIVE

To assess the reliability of a proposed novel classification system for thoracic disc herniations (TDHs).

SUMMARY OF BACKGROUND DATA BACKGROUND

TDHs are complex entities varying substantially in many factors, including size, location, and calcification. To date, no comprehensive system exists to categorize these lesions.

METHODS METHODS

Our proposed system classifies 5 types of TDHs using anatomical and clinical characteristics, with subtypes for calcification. Type 0 herniations are small (≤40% of spinal canal) TDHs without significant spinal cord or nerve root effacement; type 1 are small and paracentral; type 2 are small and central; type 3 are giant (>40% of spinal canal) and paracentral; and type 4 are giant and central. Patients with types 1-4 TDHs have correlative clinical and radiographic evidence of spinal cord compression. Twenty-one US spine surgeons with substantial TDH experience rated 10 illustrative cases to determine the system's reliability. Interobserver and intraobserver reliability were determined using the Fleiss kappa coefficient. Surgeons were also surveyed to obtain consensus on surgical approaches for the various TDH types.

RESULTS RESULTS

High agreement was found for the classification system, with 80% (range 62-95%) overall agreement and high interrater and intrarater reliability (kappa 0.604 [moderate to substantial agreement] and kappa 0.630 [substantial agreement], respectively). All surgeons reported nonoperative management of type 0 TDHs. For type 1 TDHs, most respondents (71%) preferred posterior approaches. For type 2 TDHs, responses were roughly equivalent for anterolateral and posterior options. For types 3 and 4 TDHs, most respondents (72% and 68%, respectively) preferred anterolateral approaches.

CONCLUSIONS CONCLUSIONS

This novel classification system can be used to reliably categorize TDHs, standardize description, and potentially guide the selection of surgical approach. Validation of this system with regard to treatment and clinical outcomes represent lines of future study.

Identifiants

DOI: 10.1097/BRS.0000000000004701 PMID: 37134139

pubmed: 37134139

doi: 10.1097/BRS.0000000000004701

pii: 00007632-990000000-00338

doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Informations de copyright

Déclaration de conflit d'intérêts

The authors report no conflicts of interest.