Lee KH, Park HJ, Lee SY, et al. - The aim was to evaluate the inter-observer reliability of the Kang system was investigated among radiologists, residents, and clinicians and the association between radiologic and clinical findings were explored. This study included a sum of 133 patients (M:F = 44:89, mean age 56 years) who had undergone MRI of the cervical spine at our hospital were included.  Central cervical spinal stenosis (CCSS) grade was measured by two radiologists, two trainees, and two clinicians at the narrowest point according to the grading system suggested by Kang et al. Associated neurologic manifestations were analyzed by different clinician (a neurosurgeon). Using kappa statistics, the inter-reader agreement among the radiologists, trainees, and clinicians was examined. Nonparametric correlation analysis (Spearman’s correlation) was applied to measure the clinical correlation (R) between grade and positive clinical manifestations (PCMs). Although the reproducibility of the clinician is slightly lower than radiologist and trainee of the radiology department, the Kang MRI grading system of CCSS based on mid-sagittal MRI serves objective, reliable, and reproducible evaluation regardless of field proficiency of the reader. A moderate association was found between image interpretation and clinical findings irrespective of the reader’s main field of research.