The interrater reliability of the novel Udby classification of Modic Changes: A first estimate

Sherwood, David; Häring, R; Gill, Benjamin; Miller, Scott; Epps, Adam; Zhivotenko, Oksana; Khan, Seema; Swenson, Theodora Lananh; Gardner, James E.; Roehmer, Christian; Martin, Dann; Kennedy, David J.; Schneider, Byron J.; Modic, Michael T.; Udby, Peter Muhareb

doi:10.1016/j.inpm.2022.100092

Cited by 2 publications

(4 citation statements)

References 20 publications

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“…Overall, the results from this study are consistent and in agreement with the results from previous studies. 42,44,57 These findings may indicate a paradigm shift in terms of understanding spine phenotypes. Previous studies have primarily viewed MC type as the significant spine phenotype.…”

Section: Discussionmentioning

confidence: 88%

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The Clinical Significance of the Modic Changes Grading Score

Udby

Modic

Elmose

et al. 2022

Global Spine Journal

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Study design Cross-sectional retrospective observational study. Objective To evaluate the reliability and clinical utility of the Modic changes (MC) grading score. Method Patients from the Danish national spine registry, DaneSpine, scheduled for lumbar discectomy were identified. MRI of patients with MC were graded based on vertical height involvement: Grade A (<25%), Grade B (25%-50%), and Grade C (>50%). All MRIs were reviewed by 2 physicians to evaluate the reliability of the MC grade. Results Of 213 patients included, 142 patients had MC, 71 with MC-1 and 71 with MC-2; 34% were Grade A, 45% were Grade B, and 21% were Grade C. MC grade demonstrated substantial intra-rater (κ = .68) and inter-rater (κ = .61) reliability. A significantly higher proportion (n = 40, 57%) of patients with MC-1 had a severe MC grade compared to patients with MC-2 (n = 30, 43%, P < .001). Severe MC grade was associated with the presence of severe lumbar disc degeneration (DD) (Pfirrmann grade = V, P = .024), worse preoperative ODI (52.49 vs 44.17, P = .021) and EQ-5D scores (.26 vs .46, P = .053). MC alone including type was not associated with a significant difference in patient-reported outcomes ( P > .05). Conclusion The MC grade score was demonstrated to have substantial intra- and inter-observer reliability. Severe MC grade was associated with both severe DD and MC type, being more prevalent in patients with MC-1. The MC grade was also significantly associated with worse disability and reduced health-related quality of life. Results from the study suggest that MC grade is more clinically important than MC type.

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Section: Discussionmentioning

confidence: 88%

“…Overall, the results from this study are consistent and in agreement with the results from previous studies. 42 , 44 , 57 …”

Section: Discussionmentioning

confidence: 99%

The Clinical Significance of the Modic Changes Grading Score

Udby

Modic

Elmose

et al. 2022

Global Spine Journal

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“…The presence of Modic changes correlate with the reproduction of a patient's symptoms via provocative discography at the affected level 13 . The appropriate identification and characterization of the extent and type of Modic change may have clinical significance 1,6,8,13–16 …”

Section: Introductionmentioning

confidence: 99%

“…13 The appropriate identification and characterization of the extent and type of Modic change may have clinical significance. 1,6,8,[13][14][15][16] Basivertebral nerve ablation (BVNA) is a procedure in which the intraosseous nerves within a lumbar vertebral body are ablated using a radiofrequency probe. 17,18 The rationale for the procedure is that among patients whose chronic low back pain is caused by an injury to a vertebral endplate, relief of pain may be possible by ablating the nerves which innervate that endplate.…”

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confidence: 99%

The interrater reliability of Modic changes among a potential basivertebral nerve ablation population: Why AC1 may be preferred to kappa

Sherwood

Häring

Schirmer

et al. 2022

Journal Orthopaedic Research

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Interrater reliability of Modic changes is subject to variables which affect consistency in reporting. Given the importance of Modic change identification for basivertebral nerve ablation (BVNA) candidacy, interrater reliability for this specific cohort has not yet been reported. Twenty lumbar magnetic resonance images of potential basivertebral nerve candidates were independently reviewed by two neuroradiologists and two interventional spine physiatrists for the presence and characterization of Modic changes. The kappa value of their agreement on the presence of Modic changes was 0.52 (95% confidence interval [CI] 0.37-0.67), whereas agreement on the type of Modic change was 0.51 (95% CI 0.37-0.65). Using an alternative methodology for measuring interrater reliability (Gwet's AC1) yielded the identification of the presence of Modic changes at AC1 0.51 (95% CI 0.36-0.66), whereas agreement on the type of Modic change was AC1 0.75 (95% CI 0.66-0.83). While less common, AC1 may be preferred in the appropriate cohort to kappa as it mitigates some of the pitfalls to which kappa values may be victim. Ultimately, our results are in-line with previous reports of interrater reliability results for Modic changes in other cohorts and should serve to caution those who perform BVNA regarding interrater agreement of the imaging crux of the procedure.

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The interrater reliability of the novel Udby classification of Modic Changes: A first estimate

Cited by 2 publications

References 20 publications

The Clinical Significance of the Modic Changes Grading Score

The Clinical Significance of the Modic Changes Grading Score

The interrater reliability of Modic changes among a potential basivertebral nerve ablation population: Why AC1 may be preferred to kappa

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