KUMJ | VOL. 24 | NO. 2 | ISSUE 95 | APRIL - JUNE, 2026

Intra- and inter-rater Reliability of MRI-based Classifications of Degenerative Changes in the Cervical Spine using Objective Criteria
Shrestha D, Danielsen E, Parajuli B, Karki S, Simkhada S, Grotle M, Nygaard OP, Solberg TK

Abstract:
Background Magnetic resonance imaging (MRI) is the modality of choice for the radiological evaluation of neck pain, both with and without neurological symptoms. Magnetic resonance imaging offers a detailed, non-invasive investigation of the spinal cord and nerve roots without exposing patients to radiation. Objective To determine the intra- and inter-rater reliability of clinically relevant magnetic resonance imaging classifications of degenerative cervical spine changes in a Nepalese working population. Method Standardized magnetic resonance imaging examinations of the cervical segments C2/3 to C7/Th1 were conducted as part of a cross-sectional, case-control study of presumably healthy Nepalese males, i.e., professional porters and white-collar workers. Two radiologists independently assessed nine parameters: Pfirrmann grade, anterior osteophytes, disc-osteophyte complex, neural foraminal stenosis, Schmorl’s node, Modic changes, spinal canal stenosis, scoliosis, and kyphosis. The same parameters were reassessed after a one-week interval. Gwet’s agreement coefficient (AC1) was the main agreement measure. Cohen’s kappa and tetrachoric correlation were also reported to improve interpretability of the results. Result Intra-rater reliability for both raters ranged from substantial to almost perfect agreement (AC1: 0.63 to 0.98). Rater II showed somewhat higher agreement than rater I. Inter-rater reliability was substantial to almost perfect for all findings (AC1: 0.62 to 0.90), except for spinal canal stenosis (AC1: 0.51), which had moderate agreement. Conclusion The intra- and inter-rater reliability of the magnetic resonance imaging findings classifying degenerative changes in the cervical spine were acceptable among presumably healthy workers.
Keyword : Degenerative cervical changes, Magnetic resonance imaging, Reliability, Nepal