The Haleem-Botchu classification: a novel CT-based classification for lumbar foraminal stenosis

Area of Science:

• Radiology
• Medical Imaging
• Spinal Diagnostics

Background:

• Currently, no clinical CT-based classification system exists for lumbar foraminal stenosis.
• MRI is often inaccessible, costly, and contraindicated for some patients.
• This highlights the need for an alternative imaging classification.

Purpose of the Study:

• To propose and evaluate the reproducibility of a novel CT-based classification system for lumbar foraminal stenosis.
• To assess the agreement of the CT classification against the established MRI-based grading system.
• To determine the interobserver and intraobserver reliability of the new CT classification.

Main Methods:

• A four-grade classification system (Grade 0-3) was developed based on CT imaging of lumbar foramina.
• Two radiologists independently reviewed 800 lumbar foramina from 100 patients (age >60) with both CT and MRI scans.
• Agreement was assessed using the weighted kappa statistic, including interobserver and intraobserver analyses.

Main Results:

• The CT-based classification demonstrated good correlation with the MRI grading system (kappa = 0.81).
• High intraobserver agreement was observed for both readers (kappa = 0.89 and 0.98).
• The study included 100 patients with a mean age of 68.5 years.

Conclusions:

• The novel CT-based classification system is reproducible and correlates well with MRI findings.
• This CT classification can serve as a safe and accurate replacement for MRI in grading lumbar foraminal stenosis.
• It offers a practical solution for assessing lumbar foraminal stenosis when MRI is not feasible.