MRI classification system for lumbar disc degeneration

Last revised by Dr Henry Knipe on 25 Aug 2021

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

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