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Chiropractic Research Review

Variance in the Morphologic Assessment of Disk Displacement Using MRI

Several observational studies and anecdotes exist that compare the sizes of lumbar disk herniations as seen on magnetic resonance imaging (MRI), before and after treatment. There are several limiting factors in measuring disk displacement.

One of these is the variation in measuring techniques used by radiologists; another is the discrepancy in distinguishing different types of disk lesions. Also, the reliability of radiologists to measure and categorize disk lesions is unknown. Before well-designed studies investigating cause-and-effect relationships in disk sizes (before and after care) can be performed, these measurement issues must be addressed.

The authors of this study sought to determine the average sizes for normal and displaced disks, and the dependability of measurements made by trained chiropractic radiologists. The radiologists assessed 122 MRI scans of 1,781 lumbar disks with two instruments: a backlit digitizer and a hand ruler. Comparisons were made between the two measurement methods. The examiners' ability to reproduce their own measurements (intra-examiner reliability), as well as comparisons to one another's measurements (inter-examiner reliability), were assessed for both instruments.

"Clear size differences between different types of disk displacement were noted," the authors wrote. Inter-examiner measurements were more accurate than intra-examiner measurements, and there was significant variability between the classifications of disk displacements. Ruler and digitizer measurements were "remarkably close."

The authors conclude that multiple factors limit the interpretation of MRI scans, and that greater variability between measurements would probably be seen in general practice, because the evaluators in this study had all been trained in the same fashion. They recommend that chiropractors should "continue to address each of these shortcomings to arrive at conclusions that could ultimately affect diagnostic procedures, treatment protocols, reimbursements, and medico-legal issues."

Cooley JR, Danielson CD, Schultz GD, et al. Posterior disk displacement: Morphologic assessment and measurement reliability - lumbar spine. Journal of Manipulative and Physiological Therapeutics, June 2001: 24(5), pp. 317-326.
Reprints: Tel: (800) 325-4177 (ext. 4350); Fax: (314) 432-1380

Chiropractic Research Review

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