Magnetic Resonance Imaging Interpretation in Patients with Sciatica Who Are Potential Candidates for Lumbar Disc Surgery

Background: Magnetic Resonance Imaging (MRI) is considered the mainstay imaging investigation in patients suspected of lumbar disc herniations. Both imaging and clinical findings determine the final decision of surgery. The objective of this study was to assess MRI observer variation in patients with sciatica who are potential candidates for lumbar disc surgery. Methods: Patients for this study were potential candidates (n = 395) for lumbar disc surgery who underwent MRI to assess eligibility for a randomized trial. Two neuroradiologists and one neurosurgeon independently evaluated all MRIs. A four point scale was used for both probability of disc herniation and root compression, ranging from definitely present to definitely absent. Multiple characteristics of the degenerated disc herniation were scored. For inter-agreement analysis absolute agreements and kappa coefficients were used. Kappa coefficients were categorized as poor (<0.00), slight (0.00-0.20), fair (0.21-0.40), moderate (0.41-0.60), substantial (0.61-0.80) and excellent (0.81-1.00) agreement. Results: Excellent agreement was found on the affected disc level (kappa range 0.81-0.86) and the nerve root that most likely caused the sciatic symptoms (kappa range 0.86-0.89). Interobserver agreement was moderate to substantial for the probability of disc herniation (kappa range 0.57-0.77) and the probability of nerve root compression (kappa range 0.42-0.69). Absolute pairwise agreement among the readers ranged from 90-94% regarding the question whether the probability of disc herniation on MRI was above or below 50%. Generally, moderate agreement was observed regarding the characteristics of the symptomatic disc level and of the herniated disc. Conclusion: The observer variation of MRI interpretation in potential candidates for lumbar disc surgery is satisfactory regarding characteristics most important in decision for surgery. However, there is considerable variation between observers in specific characteristics of the symptomatic disc level and herniated disc.