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Diagnostic treatment-level discrepancies in patients with lumbosacral radicular pain and lumbar spine anomalies
  1. Bart Liebrand1,
  2. Koen Brakel2,
  3. Arthur Boon3,
  4. Walter van der Weegen4,
  5. Selina van der Wal5 and
  6. Kris CP Vissers5
  1. 1Department of Anaesthesiology and Pain Medicine, St Anna Hospital, Geldrop, The Netherlands
  2. 2Department of Radiology, St Anna Hospital, Geldrop, The Netherlands
  3. 3Department of Neurology, St Anna Hospital, Geldrop, The Netherlands
  4. 4Department of Orthopaedic Surgery, St Anna Hospital, Geldrop, The Netherlands
  5. 5Department of Anesthesiology, Pain and Palliative Medicine, Radboudumc, Nijmegen, The Netherlands
  1. Correspondence to Dr Bart Liebrand, Department of Anaesthesiology and Pain Medicine, St Anna Hospital, 5664 EH Geldrop, The Netherlands; b.liebrand{at}st-anna.nl

Abstract

Background Lumbosacral transitional vertebra can result in an anomalous number of lumbar vertebrae associated with wrong level treatment. The primary aim of this study was to characterize discrepancies between reported referring levels and levels from MRI reports with treated levels. The secondary aim was to analyze interobserver variability between a pain physician and a radiologist when determining levels and classifying lumbosacral transitional vertebrae.

Methods Between February 2016 and October 2019, a retrospective case series of prospectively collected data of the affected levels mentioned in referrals, MRI reports and treated levels was performed. The counting process, level determination, classification of lumbosacral transitional vertebrae and a secondary control were carried out by independent researchers using a standard methodology.

Results Of the 2443 referrals, 143 patients had an anomalous number of lumbar vertebrae; of these, 114 were included for analysis. The vertebral level noted in the patient’s file, in the referral, and the reported level of treatment differed in 40% of these cases. The vertebral level between the MRI reports and treatment differed in 46% of cases. The interobserver reliability (radiologist vs pain physician) for classifying a transitional vertebra was fair ((κ=0.40) and was substantial (κ=0.70) when counting the vertebrae.

Conclusion In the presence of lumbar spine anomalies, we report a high prevalence of discrepancies between referral levels and MRI pathological findings with treatment levels. Further research is needed to better understand clinical implications.

  • back pain
  • diagnostic techniques and procedures
  • neuralgia
  • pain management

Data availability statement

Data are available upon reasonable request. There are no contradictory statements.

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Data availability statement

Data are available upon reasonable request. There are no contradictory statements.

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Footnotes

  • Contributors Special thanks go to Nenah Konadu and Kaley Bons for doing their academic internship and assistance in creating the database and statistical analysis. Guarantor author: Liebrand.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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