Radiology Reports Do Not Accurately Portray the Severity of Cervical Neural Foraminal Stenosis.

Authors

• Yunsoo Lee
• Tariq Ziad Issa
• Aditya S Mazmudar
• Omar H Tarawneh
• Gregory R Toci
• Mark J Lambrechts
• Eric J DiDomenico
• Daniel Kwak
• Alexander N Becsey
• Tyler W Henry
• Ameer A Haider
• Collin J Larkin
• Ian David Kaye
• Mark F Kurd
• Jose A Canseco
• Alan S Hilibrand
• Alexander R Vaccaro
• Christopher K Kepler
• Gregory D Schroeder

Publication/Presentation Date

10-1-2024

Abstract

STUDY DESIGN: Retrospective study.

OBJECTIVE: (1) To compare cervical magnetic resonance imaging (MRI) radiology reports to a validated grading system for cervical foraminal stenosis (FS) and (2) to evaluate whether the severity of cervical neural FS on MRI correlates to motor weakness or patient-reported outcomes.

BACKGROUND: Radiology reports of cervical spine MRI are often reviewed to assess the degree of neural FS. However, research looking at the association between these reports and objective MRI findings, as well as clinical symptoms, is lacking.

PATIENTS AND METHODS: We retrospectively identified all adult patients undergoing primary 1 or 2-level anterior cervical discectomy and fusion at a single academic center for an indication of cervical radiculopathy. Preoperative MRI was assessed for neural FS severity using the grading system described by Kim and colleagues for each level of fusion, as well as adjacent levels. Neural FS severity was recorded from diagnostic radiologist MRI reports. Motor weakness was defined as an examination grade < 4/5 on the final preoperative encounter. Regression analysis was conducted to evaluate whether the degree of FS by either classification was related to patient-reported outcome measure severity.

RESULTS: A total of 283 patients were included in the study, and 998 total levels were assessed. There were significant differences between the MRI grading system and the assessment by radio-logists ( P < 0.001). In levels with moderate stenosis, 28.9% were classified as having no stenosis by radiology. In levels with severe stenosis, 29.7% were classified as having mild-moderate stenosis or less. Motor weakness was found similarly often in levels of moderate or severe stenosis (6.9% and 9.2%, respectively). On regression analysis, no associations were found between baseline patient-reported outcome measures and stenosis severity assessed by radiologists or MRI grading systems.

CONCLUSION: Radiology reports on the severity of cervical neural FS are not consistent with a validated MRI grading system. These radiology reports underestimated the severity of neural foraminal compression and may be inappropriate when used for clinical decision-making.

LEVEL OF EVIDENCE: Level III.

Volume

37

Issue

8

First Page

351

Last Page

356

ISSN

2380-0194

Published In/Presented At

Lee, Y., Ziad Issa, T., Mazmudar, A. S., Tarawneh, O. H., Toci, G. R., Lambrechts, M. J., DiDomenico, E. J., Kwak, D., Becsey, A. N., Henry, T. W., Haider, A. A., Larkin, C. J., Kaye, I. D., Kurd, M. F., Canseco, J. A., Hilibrand, A. S., Vaccaro, A. R., Kepler, C. K., & Schroeder, G. D. (2024). Radiology Reports Do Not Accurately Portray the Severity of Cervical Neural Foraminal Stenosis. Clinical spine surgery, 37(8), 351–356. https://doi.org/10.1097/BSD.0000000000001603

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

38490967

Department(s)

Administration and Leadership

Document Type

Article