Comparative intra‑ and inter‑observer reliability of two methods for evaluating intraoperative ultrasonography‑based spinal cord hyperechogenicity intensity in degenerative cervical myelopathy

BMC Musculoskeletal Disorders, 2022 · DOI: https://doi.org/10.1186/s12891-022-05517-0 · Published: June 3, 2022

Simple Explanation

This study evaluates the reliability of two methods (GVR-A and GVR-B) for measuring spinal cord hyperechogenicity using intraoperative ultrasound (IOUS) in patients with degenerative cervical myelopathy (DCM). The goal was to find a more reliable method for assessing spinal cord changes during surgery. The study involved measuring gray values from ultrasound images of the spinal cord and calculating gray value ratios (GVRs) using two different formulas. The consistency of these measurements was then compared between different observers (inter-observer reliability) and within the same observer at different times (intra-observer reliability). The researchers found that one method (GVR-B), which uses the dural sac as a reference point, had better inter- and intra-observer reliability than the other method (GVR-A). This suggests that GVR-B is a more consistent and reliable way to evaluate spinal cord hyperechogenicity during surgery for DCM.

Study Duration

October 2018 and September 2019

Participants

28 patients (20 males and 8 females)

Evidence Level

Not specified

Key Findings

1
GVR-B has better repeatability of gray value measurement, smaller relative standard deviation (RSD%) compared with GVR-A.
2
The intraobserver reliability was classified as ‘‘moderate agreement’’ for GVR-A and good for GVR-B.
3
For GVR-B, interobserver reliability was classified as ‘‘substantial to almost perfect agreement’’.

Research Summary

This study compared two methods (GVR-A and GVR-B) for evaluating spinal cord hyperechogenicity intensity using intraoperative ultrasound (IOUS) in patients with degenerative cervical myelopathy (DCM) to determine which method had better inter- and intra-observer reliability. The results indicated that GVR-B, which uses the dural sac as a reference, demonstrated significantly higher inter- and intra-observer reliability compared to GVR-A, suggesting it is a more consistent and reliable method. The authors concluded that GVR-B is a preferable method for evaluating spinal cord hyperechogenicity in DCM patients undergoing French-door laminoplasty and can be used as a basis for future studies.

Practical Implications

Improved reliability in assessing spinal cord condition

Using GVR-B can lead to more consistent and reliable assessments of spinal cord hyperechogenicity during surgery for DCM, reducing variability in measurements.

Better prognostic prediction

The more reliable GVR-B method may improve the ability to predict neurological recovery after surgery based on intraoperative ultrasound findings.

Standardization of research methods

Adopting GVR-B as the standard method can facilitate comparison of results across different studies investigating spinal cord hyperechogenicity in DCM.