Eur J Orthop Surg Tr
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Eur J Orthop Surg Tr · Sep 2004
Correlative analysis of reliability and validity of plain radiology, MOS short-form health survey and surgical examination in making decision for treatment of chronic low back pain patients.
The aim of this study was to determine inter- and intraobserver agreement between spine surgeons and orthopedic radiologists in recognizing distinct degenerative pathology on plain lumbosacral roentgenograms; to estimate the validity (sensitivity and specificity) to make a surgical decision by correlating Short form-36 Health Survey (SF-36) scores and roentgenographic degenerative pathology; and to determine the intra- and interobserver agreement between radiologists, surgeons, and authors in making a surgical decision for treatment on the basis of distinct roentgenographic pathology, SF-36 scores, clinical findings derived from physical examination, or combined. The authors followed three routes to objectively assess the reliability and validity of the surgical decision in chronic low back pain patients: First, 100 consecutive male patients who suffered from low back pain were examined by the authors physically, using imaging techniques (including plain roentgenograms, CT-scan, or/and MRI), and SF-36 survey. Two senior orthopedic radiologists and two senior spine surgeons were asked to read blinded a set of 100 roentgenograms of the lumbar spine in two sessions. ⋯ This investigation showed that distinct degenerative lumbar spinal pathology can be identified on plain roentgenographs with similarly high accuracy by orthopedic, radiologists, and spine surgeons. The sensitivity and specificity of recognizing abnormal and normal roentgenograms using normal and abnormal SF-36 data was low because of the subjective nature of the SF-36 survey. This study additionally concluded that any surgical decision should not be taken on the basis of any roentgenographic pathology or on what the patient says in the SF-36 questionnaire, but on the basis of matched SF-36 scores, roentgenographic and imaging evaluation, and physical examination data.