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Lumbar spinal canal stenosis grading systems by Lee and Schizas

Case contributed by Francis Deng
Diagnosis not applicable

Presentation

Visual grading of lumbar spinal canal stenosis based on axial T2-weighted MRI

Lee classification

Diagram
  • Grade 0: no stenosis: no obliteration of the anterior cerebrospinal fluid space
  • Grade 1: mild stenosis: mild obliteration of the anterior cerebrospinal fluid space and all cauda equina clearly separated from each other
  • Grade 2: moderate stenosis: moderate obliteration of the anterior cerebrospinal fluid space and some cauda equina aggregation
  • Grade 3: severe stenosis: severe obliteration of the anterior cerebrospinal fluid space, marked compression of the dural sac, and the entire cauda equina appearing as one bundle

Schizas classification

Diagram
  • Grade A: no or minor stenosis
    • A1: rootlets lying dorsally and occupying less than half of the dural sac area.
    • A2: rootlets lying dorsally with a horseshoe configuration
    • A3: rootlets lying dorsally and occupying more than half of the dural sac area
    • A4: rootlets lying centrally and occupying the majority of the dural sac area
  • Grade B: moderate stenosis: rootlets occupying the entire dural sac, but rootlets can still be individualized
  • Grade C: severe stenosis: no recognizable rootlets with complete effacement of cerebrospinal fluid space, but epidural fat is present posteriorly
  • Grade D: extreme stenosis: no recognizable rootlets and no epidural fat posteriorly

Case Discussion

Authors: Yeon-jee Ko, Eugene Lee, Joon Woo Lee, Chi Young Park, Jungheum Cho, Yusuhn Kang, Joong Mo Ahn.

Original file: https://doi.org/10.1371/journal.pone.0233633 (published in PLOS ONE)

Modifications: The original figures were divided, cropped, and captioned separately.

License: The content is distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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