Medical Student The Ohio State University College of Medicine
Introduction: To characterize spinal stenosis, there are over a dozen grading systems based off spinal imaging available. With so many systems in use, it is important to know the validity and reliability of each. The objective of this project is to determine the most established spinal stenosis grading systems and determine the clinical validity and reliability of each.
Methods: A comprehensive literature search was conducted in Scopus, PubMed, and Embase, and imported into Covidence. Two reviewers independently performed title and abstract screening of 1,517 publications. 402 papers qualified for the full-text screening stage and were independently reviewed by two reviewers. From the full-text screening, 50 papers were chosen for preliminary data extraction. From the 50 manuscripts, 13 different grading systems were mentioned. However, most systems were only referenced in one manuscript, so only the grading systems that were referenced in over two manuscripts were included in the final analysis. 35 manuscripts qualified for the final data extraction.
Results: There were five grading systems referenced in multiple manuscripts: Lee, Kang, Schizas, Park, and Kim. The most cited grading system was Schizas (10 manuscripts), followed by Lee (five manuscripts). The manuscripts were then divided into two groups based on whether they discussed clinical validity (23 manuscripts) or reliability (12 manuscripts). For clinical validity, Schizas had the most evidence, with seven manuscripts describing its strong correlation between severe symptomology and higher grades. It was followed by Lee and Park, which each had three manuscripts proving their validity. Lee demonstrated a strong correlation of grading with symptomology and future surgical intervention. Park demonstrated moderate-high correlation of grading with clinical symptoms. All grading systems demonstrated significant reliability.
Conclusion : Although there are over a dozen spinal stenosis grading systems that have been described in literature, only five have been well-characterized and examined through the lens of clinical validity and reliability.
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