Inter-rater reliability of MRI superior articular process angle measurement for use in the modified approach to cervical transforaminal epidural steroid injections

David Levi; Scott Horn; Dustin Runzo; Madeline Linn

doi:10.1016/j.inpm.2023.100176

Inter-rater reliability of MRI superior articular process angle measurement for use in the modified approach to cervical transforaminal epidural steroid injections

Interv Pain Med. 2023 Jan 21;2(1):100176. doi: 10.1016/j.inpm.2023.100176. eCollection 2023 Mar.

Authors

David Levi¹, Scott Horn¹, Dustin Runzo², Madeline Linn³

Affiliations

¹ Jordan-Young Institute, Virginia Beach, VA, 23462, USA.
² Eastern Virginia Medical School, Norfolk, VA, 23507, USA.
³ Lincoln Memorial University DeBusk College of Osteopathic Medicine, Knoxville, TN, 37932, USA.

Abstract

Background: Upper extremity radicular pain is commonly treated with a cervical transforaminal epidural steroid injection (CTFESI). Recently, a new technique, the modified approach CTFESI, has been developed with a theoretical safety advantage to avoid the neurovascular structures. This approach requires an angle measurement of the superior articular process (SAP) on MRI. The inter-rater reliability of this angle measurement among practicing physicians is yet to be investigated.

Objective: The purpose of this study was to determine the inter-rater reliability of SAP angle measurements on MRI.

Methods: Three raters independently measured the SAP angle on 50 cervical MRIs. A two-way, mixed effects, absolute agreement, single rater statistical model was used to determine the intraclass correlation coefficient (ICC) between all three raters, as well as between each pair of raters.

Results: Inter-rater reliability among all raters showed good reliability with an ICC = 0.837709 (95% CI 0.75-0.9, p < 0.001). Similarly, good inter-rater reliability was found between each of the pairs of raters.

Conclusion: This study demonstrates good inter-rater reliability of MRI SAP angle measurement among clinicians for use in the modified CTFESI approach.