MRI classification system for lumbar disc degeneration

Last revised by Henry Knipe on 25 Aug 2021

Citation, DOI, disclosures and article data

Citation:

Di Muzio B, Knipe H, Goel A, et al. MRI classification system for lumbar disc degeneration. Reference article, Radiopaedia.org (Accessed on 16 Apr 2024) https://doi.org/10.53347/rID-27904

DOI:

https://doi.org/10.53347/rID-27904

Permalink:

https://radiopaedia.org/articles/27904

rID:

27904

Article created:

25 Feb 2014, Bruno Di Muzio ◉ ◈

Disclosures:

At the time the article was created Bruno Di Muzio had no recorded disclosures.

View Bruno Di Muzio's current disclosures

Last revised:

25 Aug 2021, Henry Knipe ◉ ◈

Disclosures:

At the time the article was last revised Henry Knipe had no recorded disclosures.

View Henry Knipe's current disclosures

Revisions:

8 times, by 6 contributors - see full revision history and disclosures

Systems:

Musculoskeletal, Spine

Sections:

Classifications

Tags:

spine, cases

Synonyms:

Pfirrmann disc classification
DDD classification
Modified Pfirrman grading system
Pfirrmann grading system

Disc degeneration can be graded on MRI T2 weighted images.

Usage

The Pfirrmann grading system is the most widely known classification for intervertebral disc degeneration and is used in both clinical and research capabilities ^2,3. The intra- and inter-observer agreement of the Pfirrmann grading system is excellent ³.

Classification

Pfirrmann grading system

grade I: disc is homogeneous with bright hyperintense white signal intensity and normal disc height
grade II
- disc is inhomogeneous but keeping the hyperintense white signal
- nucleus and annulus are clearly differentiated, and a gray horizontal band could be present
- disc height is normal
grade III
- disc is inhomogeneous with an intermittent gray signal intensity
- distinction between nucleus and annulus is unclear
- disc height is normal or slightly decreased
grade IV
- disc is inhomogeneous with a hypointense dark gray signal intensity
- there is no more distinction between the nucleus and annulus
- disc height is slightly or moderately decreased
grade V
- disc is inhomogeneous with a hypointense black signal intensity
- there is no more difference between the nucleus and annulus
- the disc space is collapsed

Modified Pfirrman grading system

A modified classification was proposed in 2007 by Griffith et al. ² to better categorize degenerative discs in older patients where most discs are Pfirrman grade III or IV.

grade 1
- uniformly hyperintense, equal to CSF
- distinct junction between inner and outer annular fibers posteriorly
- normal disc height
grade 2
- hyperintense (between presacral fat and CSF) +/- hypointense intranuclear cleft
- distinct junction between inner and outer annular fibers posteriorly
- normal disc height
grade 3
- hyperintense (less than presacral fat)
- distinct junction between inner and outer annular fibers posteriorly
- normal disc height
grade 4
- midly hyperintense (slightly more than outer annular fibers)
- indistinct junction between inner and outer annular fibers posteriorly
- normal disc height
grade 5
- hypointense (equal to outer annular fibers)
- indistinct junction between inner and outer annular fibers posteriorly
- normal disc height
grade 6
- hypointense
- indistinct junction between inner and outer annular fibers posteriorly
- <30% reduction in disc height
grade 7
- hypointense
- indistinct junction between inner and outer annular fibers posteriorly
- 30-60% reduction in disc height
grade 8
- hypointense
- indistinct junction between inner and outer annular fibers posteriorly
- >60% reduction in disc height