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Interrater Reliability of the Postoperative Epidural Fibrosis Classification: A Histopathologic Study in the Rat Model.

Sae-Jung S, Jirarattanaphochai K, Sumananont C, Wittayapairoj K, Sukhonthamarn K - Asian Spine J (2015)

Bottom Line: A statistical analysis was performed.The percent agreement and intraclass correlation coefficient (ICC) between each pair of assessors varied from 73.5% to 81.3% and from 0.81 to 0.86, respectively.The overall ICC was 0.83 (95% confidence interval, 0.81-0.86).

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.

ABSTRACT

Study design: Agreement study.

Purpose: To validate the interrater reliability of the histopathological classification of the post-laminectomy epidural fibrosis in an animal model.

Overview of literature: Epidural fibrosis is a common cause of failed back surgery syndrome. Many animal experiments have been developed to investigate the prevention of epidural fibrosis. One of the common outcome measurements is the epidural fibrous adherence grading, but the classification has not yet been validated.

Methods: Five identical sets of histopathological digital files of L5-L6 laminectomized adult Sprague-Dawley rats, representing various degrees of postoperative epidural fibrous adherence were randomized and evaluated by five independent assessors masked to the study processes. Epidural fibrosis was rated as grade 0 (no fibrosis), grade 1 (thin fibrous band), grade 2 (continuous fibrous adherence for less than two-thirds of the laminectomy area), or grade 3 (large fibrotic tissue for more than two-thirds of the laminectomy area). A statistical analysis was performed.

Results: Four hundred slides were independently evaluated by each assessor. The percent agreement and intraclass correlation coefficient (ICC) between each pair of assessors varied from 73.5% to 81.3% and from 0.81 to 0.86, respectively. The overall ICC was 0.83 (95% confidence interval, 0.81-0.86).

Conclusions: The postoperative epidural fibrosis classification showed almost perfect agreement among the assessors. This classification can be used in research involving the histopathology of postoperative epidural fibrosis; for example, for the development of preventions of postoperative epidural fibrosis or treatment in an animal model.

No MeSH data available.


Related in: MedlinePlus

The schematic drawing of the cross-section of the laminectomized lumbar spine showing epidural fibrosis. The epidural fibrosis adheres to the dura in a curvilinear pattern.
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Figure 1: The schematic drawing of the cross-section of the laminectomized lumbar spine showing epidural fibrosis. The epidural fibrosis adheres to the dura in a curvilinear pattern.

Mentions: As shown in Fig. 1, the dura and epidural area were assessed. The epidural fibrosis was graded at the area of the posterior aspect of the dura between the left and right rims of the laminectomy site (Fig. 2, point A to B). All assessors were oriented with the epidural fibrosis classification according Table 1 and Figs. 3 and 4. The extent of epidural fibrosis was rated as grade 0 (no fibrosis), grade 1 (mild degree), grade 2 (moderate degree), or grade 3 (severe degree) [4].


Interrater Reliability of the Postoperative Epidural Fibrosis Classification: A Histopathologic Study in the Rat Model.

Sae-Jung S, Jirarattanaphochai K, Sumananont C, Wittayapairoj K, Sukhonthamarn K - Asian Spine J (2015)

The schematic drawing of the cross-section of the laminectomized lumbar spine showing epidural fibrosis. The epidural fibrosis adheres to the dura in a curvilinear pattern.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4522450&req=5

Figure 1: The schematic drawing of the cross-section of the laminectomized lumbar spine showing epidural fibrosis. The epidural fibrosis adheres to the dura in a curvilinear pattern.
Mentions: As shown in Fig. 1, the dura and epidural area were assessed. The epidural fibrosis was graded at the area of the posterior aspect of the dura between the left and right rims of the laminectomy site (Fig. 2, point A to B). All assessors were oriented with the epidural fibrosis classification according Table 1 and Figs. 3 and 4. The extent of epidural fibrosis was rated as grade 0 (no fibrosis), grade 1 (mild degree), grade 2 (moderate degree), or grade 3 (severe degree) [4].

Bottom Line: A statistical analysis was performed.The percent agreement and intraclass correlation coefficient (ICC) between each pair of assessors varied from 73.5% to 81.3% and from 0.81 to 0.86, respectively.The overall ICC was 0.83 (95% confidence interval, 0.81-0.86).

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.

ABSTRACT

Study design: Agreement study.

Purpose: To validate the interrater reliability of the histopathological classification of the post-laminectomy epidural fibrosis in an animal model.

Overview of literature: Epidural fibrosis is a common cause of failed back surgery syndrome. Many animal experiments have been developed to investigate the prevention of epidural fibrosis. One of the common outcome measurements is the epidural fibrous adherence grading, but the classification has not yet been validated.

Methods: Five identical sets of histopathological digital files of L5-L6 laminectomized adult Sprague-Dawley rats, representing various degrees of postoperative epidural fibrous adherence were randomized and evaluated by five independent assessors masked to the study processes. Epidural fibrosis was rated as grade 0 (no fibrosis), grade 1 (thin fibrous band), grade 2 (continuous fibrous adherence for less than two-thirds of the laminectomy area), or grade 3 (large fibrotic tissue for more than two-thirds of the laminectomy area). A statistical analysis was performed.

Results: Four hundred slides were independently evaluated by each assessor. The percent agreement and intraclass correlation coefficient (ICC) between each pair of assessors varied from 73.5% to 81.3% and from 0.81 to 0.86, respectively. The overall ICC was 0.83 (95% confidence interval, 0.81-0.86).

Conclusions: The postoperative epidural fibrosis classification showed almost perfect agreement among the assessors. This classification can be used in research involving the histopathology of postoperative epidural fibrosis; for example, for the development of preventions of postoperative epidural fibrosis or treatment in an animal model.

No MeSH data available.


Related in: MedlinePlus