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The Adams classification for cadaveric discograms: inter- and intra-observer error in the clinical setting
Ioannis D Agorastides1, Khai S Lam, Brian J C Freeman
1The Centre for Spinal Studies and Surgery, University Hospital, Queen's Medical Centre, Nottingham, UK. yannis@agorastides.freeserve.co.uk
Summary
The Adams classification for discogram morphology shows excellent reproducibility in clinical settings. This reliable grading system for discograms is consistent among observers with varying experience levels.
Area of Science:
- Orthopedics
- Radiology
- Spine Surgery
Background:
- The Adams classification is a foundational system for discogram morphology.
- Its clinical reproducibility has not been extensively evaluated.
- Chronic low back pain often necessitates diagnostic imaging like discography.
Purpose of the Study:
- To assess the inter- and intra-observer reliability of the Adams classification for discogram morphology in a clinical setting.
- To determine if observer experience impacts the reproducibility of the Adams classification.
Main Methods:
- Three independent observers with differing experience levels reviewed 133 discograms from 71 patients with chronic low back pain.
- Discograms were assessed in a randomized and blinded manner.
- The kappa statistic was used to calculate inter- and intra-observer agreement, with a repeat assessment after 3 weeks.
Main Results:
- Excellent inter-observer agreement (kappa=0.77-0.85) and intra-observer agreement (kappa=0.77-0.85) were achieved.
- The Adams classification demonstrated consistent reproducibility across observers regardless of experience.
Conclusions:
- The Adams classification system for discogram morphology is a reliable tool for clinical use.
- Its consistent reproducibility supports its recommendation for evaluating discogram findings in patients with low back pain.