Muhle staging system of cervical canal stenosis

Last revised by Joshua Yap on 26 Apr 2023

The Muhle staging system is a classification system used to evaluate the severity of cervical canal stenosis.

The system was developed based on a study conducted by Muhle et al. who used kinematic MRI to assess the dynamic changes of the cervical spine in patients at different stages of degenerative disease 1. They described a classification system based on both static and dynamic factors in the pathogenesis of cervical spondylotic myelopathy.

The Muhle staging system comprises of five stages from 0 to 4:

  • stage 0: physiological alignment of the cervical spine

  • stage 1: disc herniation or protrusion without cord impingement on flexion and extension

  • stage 2: cervical spondylosis with anterior cord impingement on flexion and extension, without any posterior cord encroachment or pincer effect

  • stage 3: cervical spondylosis with restricted motion of the affected segment, along with anterior or posterior cord impingement and pincer effect

  • stage 4: cervical spondylotic myelopathy with anterior and/or posterior cord impingement and pincer effect at one or multiple levels, either adjacent or distant from the primarily affected segment

NB: The Kang grading system of cervical canal stenosis, which assesses the degree of cervical spinal cord compression, is based on the Muhle staging system 1.

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