• Joshua W Little, Thomas J Grieve, Gregory D Cramer, Jeffrey A Rich, Evelyn E Laptook, Joseph P D Stiefel, and Kathleen Linaker.
• Assistant Professor, Center for Anatomical Science and Education, Department of Surgery, Saint Louis University School of Medicine, St Louis, MO.
• J Manipulative Physiol Ther. 2015 Jun 1; 38 (5): 344-51.

ObjectiveThis study tested the reliability of a 5-point ordinal scale used to grade the severity of degenerative changes of zygapophyseal (Z) joints on standard radiographs.MethodsModifications were made to a Kellgren grading system to improve agreement for grading the severity of osteoarthritic changes in lumbar Z joints. These included adding 1 grade of no degeneration, multiple radiographic views, and structured examiner training. Thirty packets of radiographic files were obtained, which included representation of all 5 grades including no degeneration (0) and Kellgren's 4-point (1-4) joint degeneration classification criteria. Radiographs were digitized to create a radiographic atlas that was given to examiners for individual study and blinded evaluation sessions. Intrarater and interrater agreement was determined by weighted κ (κw) from the examination of 79 Z joints (25 packets).ResultsUsing the modified scale and after training, examiners demonstrated a moderate-to-substantial level of interrater agreement (κw = 0.57, 0.60, and 0.68). Intrarater agreement was moderate (κw = 0.42 and 0.54).ConclusionsThe modified Kellgren 5-point grading system provides acceptable intrarater and interrater reliability when examiners are adequately trained. This grading system may be a useful method for future investigations assessing radiographic osteoarthritis of the Z joints.Copyright © 2015 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

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