Independent reliability and availability analyses of modified classification for migrated lumbar disc herniation

Area of Science:

• Spine Surgery
• Radiology
• Orthopedics

Background:

• Migrated nucleus pulposus is a common cause of low back pain.
• Accurate classification is crucial for effective treatment planning.

Purpose of the Study:

• To evaluate the reliability and clinical application of a modified classification system for migrated nucleus pulposus.
• To assess the system's value in guiding treatment strategies for migrated lumbar disc herniation.

Main Methods:

• Retrospective cohort study of 105 migrated lumbar MRI cases.
• Three spinal surgeons classified migrated disc herniations using a modified system.
• Inter- and intra-observer reliability assessed using Kappa coefficient.
• 2-year follow-up to analyze treatment outcomes and risk factors for surgery.

Main Results:

• The modified classification demonstrated moderate to high reliability.
• Higher BMI was associated with increased incidence of migrated lumbar disc herniation.
• Conservative treatment (A2, B2 types) was successful for 62.9% of patients.
• Surgical treatment led to significant improvements in low back pain and ODI scores.
• Specific surgical approaches recommended based on classification types (A1/B1 posterior, A2/B2/C1/C2 lateral).
• Disease duration (≥1 year) and BMI (≥24) identified as potential risk factors for surgical intervention.

Conclusions:

• The modified classification system for migrated nucleus pulposus is reliable and reproducible.
• Surgeon experience did not impact the reliability of the classification system.
• This classification system provides valuable guidance for treatment planning and surgical approach selection in migrated lumbar disc herniation.