Luca Papavero, Gregor Schmeiser, Ralph Kothe, Bronek Boszczyk, Oliver Heese, Yoshiharu Kawaguchi, Anna MacDowall, Claes Olerud, Nikolaos Paidakakos, Anastasios Panagiotou, Tobias Pitzen, Marcus Richter, K. Daniel Riew, Aaron Stevenson, Lee Tan, Ryo Ueshima, YH Yau, Michael Mayer
Neurospine 2020;17(1):164-171. Published online July 9, 2019
Objective To validate with a prospective study a decision-supporting coding system for the surgical approach for multilevel degenerative cervical myelopathy.
Methods Ten cases were presented on an internet platform, including clinical and imaging data. A single-approach (G1), a choice between 2 (G2), or 3 approaches (G3) were options. Senior and junior spine surgeons analyzed 7 parameters: location and extension of the compression of the spinal cord, C-spine alignment and instability, general morbidity and bone diseases, and K-line and multilevel corpectomy. For each parameter, an anterior, posterior, or combined approach was suggested. The most frequent letter or the last letter (if C) of the resulting 7-letter code (7LC) suggested the surgical approach. Each surgeon performed 2 reads per case within 8 weeks.
Results G1: Interrater reliability between junior surgeons improved from the first read (κ = 0.40) to the second (κ = 0.76, p < 0.001) but did not change between senior surgeons (κ = 0.85). The intrarater reliability was similar for junior (κ = 0.78) and senior (κ = 0.71) surgeons. G2: Junior/senior surgeons agreed completely (58%/62%), partially (24%/23%), or did not agree (18%/15%) with the 7LC choice. G3: junior/senior surgeons agreed completely (50%/50%) or partially (50%/50%) with the 7LC choice.
Conclusion The 7LC showed good overall reliability. Junior surgeons went through a learning curve and converged to senior surgeons in the second read. The 7LC helps less experienced surgeons to analyze, in a structured manner, the relevant clinical and imaging parameters influencing the choice of the surgical approach, rather than simply pointing out the only correct one.
Citations
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