MRI classification system for lumbar disc degeneration

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Disc degeneration can be graded on MRI T2 ~~spin-echo~~ weighted images ~~using a~~.

Usage

The Pfirrmann grading system ~~proposed by~~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 ~~¹~~. This classification~~~~grading system is ~~not used on routine spine reports, being more important for research purposes~~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 categorise 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 fibres posteriorly
- normal disc height
grade 2
- hyperintense (between presacral fat and CSF) +/- hypointense intranuclear cleft
- distinct junction between inner and outer annular fibres posteriorly
- normal disc height
grade 3
- hyperintense (less than presacral fat)
- distinct junction between inner and outer annular fibres posteriorly
- normal disc height
grade 4
- midly hyperintense (slightly more than outer annular fibres)
- indistinct junction between inner and outer annular fibres posteriorly
- normal disc height
grade 5
- hypointense (equal to outer annular fibres)
- indistinct junction between inner and outer annular fibres posteriorly
- normal disc height
grade 6
- hypointense
- indistinct junction between inner and outer annular fibres posteriorly
- <30% reduction in disc height
grade 7
- hypointense
- indistinct junction between inner and outer annular fibres posteriorly
- 30-60% reduction in disc height
grade 8
- hypointense
- indistinct junction between inner and outer annular fibres posteriorly
- >60% reduction in disc height

-Disc degeneration can be graded on MRI T2 spin-echo weighted images using a grading system proposed by Pfirrmann 1. This classification is not used on routine spine reports, being more important for research purposes.<ul>
+Disc degeneration can be graded on MRI T2 weighted images.<h4>Usage</h4>The Pfirrmann grading system is the most widely known classification for <a href="/articles/degenerative-disc-disease">intervertebral disc degeneration</a> 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.<h4>Classification</h4><h5>Pfirrmann grading system</h5><ul>
~~-<li>disc is inhomogeneous, but keeping the hyperintense white signal</li>~~
+<li>disc is inhomogeneous but keeping the hyperintense white signal</li>
~~-</ul>A modified classification was proposed in 2007 by Griffith et al. 2.~~
+</ul><h5>Modified Pfirrman grading system</h5>A modified classification was proposed in 2007 by Griffith et al. 2 to better categorise degenerative discs in older patients where most discs are Pfirrman grade III or IV. <ul>
+<li>
+grade 1<ul>
+<li>uniformly hyperintense, equal to CSF</li>
+<li>distinct junction between inner and outer annular fibres posteriorly</li>
+<li>normal disc height</li>
+</ul>
+</li>
+<li>
+grade 2<ul>
+<li>hyperintense (between presacral fat and CSF) +/- hypointense intranuclear cleft</li>
+<li>distinct junction between inner and outer annular fibres posteriorly</li>
+<li>normal disc height</li>
+</ul>
+</li>
+<li>
+grade 3<ul>
+<li>hyperintense (less than presacral fat)</li>
+<li>distinct junction between inner and outer annular fibres posteriorly</li>
+<li>normal disc height</li>
+</ul>
+</li>
+<li>
+grade 4<ul>
+<li>midly hyperintense (slightly more than outer annular fibres)</li>
+<li>indistinct junction between inner and outer annular fibres posteriorly</li>
+<li>normal disc height</li>
+</ul>
+</li>
+<li>
+grade 5<ul>
+<li>hypointense (equal to outer annular fibres)</li>
+<li>indistinct junction between inner and outer annular fibres posteriorly</li>
+<li>normal disc height</li>
+</ul>
+</li>
+<li>
+grade 6<ul>
+<li>hypointense</li>
+<li>indistinct junction between inner and outer annular fibres posteriorly</li>
+<li><30% reduction in disc height</li>
+</ul>
+</li>
+<li>
+grade 7<ul>
+<li>hypointense</li>
+<li>indistinct junction between inner and outer annular fibres posteriorly</li>
+<li>30-60% reduction in disc height</li>
+</ul>
+</li>
+<li>
+grade 8<ul>
+<li>hypointense</li>
+<li>indistinct junction between inner and outer annular fibres posteriorly</li>
+<li>>60% reduction in disc height</li>
+</ul>
+</li>
+</ul>

References changed:

3. Urrutia J, Besa P, Campos M et al. The Pfirrmann classification of lumbar intervertebral disc degeneration: an independent inter- and intra-observer agreement assessment. Eur Spine J. 2016;25(9):2728-2733. <a href="https://doi.org/10.1007/s00586-016-4438-z">doi:10.1007/s00586-016-4438-z</a>

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