Magnetic resonance classification of lumbar intervertebral disc degeneration

wbldb

Pfirrmann, Christian W. A.¹; Metzdorf, Alexander²; Zanetti, Marco¹; Hodler, Juerg¹; Boos, Norbert²

Magnetic resonance classification of lumbar intervertebral disc degeneration

Spine. September 1, 2001;26(17):1873-1878

©2001 Lippincott Williams & Wilkins, Inc.

Affiliations

¹Division of Musculoskeletal Radiology, Orthopedic University Hospital, Balgrist Zurich, Switzerland

²Department of Orthopedic Surgery, Orthopedic University Hospital, Balgrist Zurich, Switzerland
Abstract and keywords

Study Design: A reliability study was conducted.

Objectives: To develop a classification system for lumbar disc degeneration based on routine magnetic resonance imaging, to investigate the applicability of a simple algorithm, and to assess the reliability of this classification system.

Summary of Background Data. A standardized nomenclature in the assessment of disc abnormalities is a prerequisite for a comparison of data from different investigations. The reliability of the assessment has a crucial influence on the validity of the data. Grading systems of disc degeneration based on state of the art magnetic resonance imaging and corresponding reproducibility studies currently are sparse.

Methods: A grading system for lumbar disc degeneration was developed on the basis of the literature. An algorithm to assess the grading was developed and optimized by reviewing lumbar magnetic resonance examinations. The reliability of the algorithm in depicting intervertebral disc alterations was tested on the magnetic resonance images of 300 lumbar intervertebral discs in 60 patients (33 men and 27 women) with a mean age of 40 years (range, 10–83 years). All scans were analyzed independently by three observers. Intra- and interobserver reliabilities were assessed by calculating kappa statistics.

Results: There were 14 Grade I, 82 Grade II, 72 Grade III, 68 Grade IV, and 64 Grade V discs. The kappa coefficients for intra- and interobserver agreement were substantial to excellent: intraobserver (kappa range, 0.84– 0.90) and interobserver (kappa range, 0.69–0.81).

Complete agreement was obtained, on the average, in 83.8% of all the discs. A difference of one grade occurred in 15.9% and a difference of two or more grades in 1.3% of all the cases.

Conclusion: Disc degeneration can be graded reliably on routine T2-weighted magnetic resonance images using the grading system and algorithm presented in this investigation

Keywords: disc degeneration, intervertebral disc, magnetic resonance imaging, reliability
Links

DOI: 10.1097/00007632-200109010-00011

PubMed: 11568697

WoS: 000170914000008
History

Received: 2000-08-26

Revised: 2000-11-27

Accepted: 2001-01-01

Cited Works (3)

Year	Entry
1990	Thompson JP, Pearce RH, Schechter MT, Adams ME, Tsang IK, Bishop PB. Preliminary evaluation of a scheme for grading the gross morphology of the human intervertebral disc. Spine. May 1990;15(5):411-415.
1949	Friberg S, Hirsch C. Anatomical and clinical studies on lumbar disc degeneration. Acta Orthop Scand. 1949;19(2):222-242.
1977	Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. March 1977;33(1):159-174.

Cited By (58)

Year	Entry
2014	Sovelius R. Cervical Loading Analysis of Fighter Pilots: Studies on Cumulative Loading, Contributing Factors and Interventions [PhD thesis]. Tampere, Finland: University of Tampere School of Medicine; February 21, 2014.
2022	Gao D, Hu B, Ding B, Zhao Q, Zhang Y, Xiao L. N6-Methyladenosine-induced miR-143-3p promotes intervertebral disc degeneration by regulating SOX5. Bone. October 2022;163:116503.
2022	Udby PM, Samartzis D, Carreon LY, Andersen MØ, Karppinen J, Modic M. A definition and clinical grading of Modic changes. J Orthop Res. February 2022;40(2):301-307.
2022	Hiyama A, Suyama K, Sakai D, Tanaka M, Watanabe M. Correlational analysis of chemokine and inflammatory cytokine expression in the intervertebral disc and blood in patients with lumbar disc disease. J Orthop Res. May 2022;40(5):1213-1222.
2023	Gupta S, Xiao R, Fainor M, Mauck RL, Smith HE, Gullbrand SE. Level dependent alterations in human facet cartilage mechanics and bone morphometry with spine degeneration. J Orthop Res. March 2023;41(3):674-683.
2023	Dudli S, Heggli I, Laux CJ, Spirig JM, Wanivenhaus F, Betz M, Germann C, Farshad-Amacker NA, Herger N, Mengis T, Brunner F, Farshad M, Distler O. Role of C-reactive protein in the bone marrow of Modic type 1 changes. J Orthop Res. May 2023;41(5):1115-1122.
2023	Wang H, Zhang W, Cai Y, Guo Q, Pan L, Chu G, Chen J, Yuan Z, Li B. Moderate mechanical stimulation antagonizes inflammation of annulus fibrosus cells through YAP-mediated suppression of NF-κB signaling. J Orthop Res. December 2023;41(12):2667-2684.
2023	Jiang L, Du X, Pan Z, Yuan Y, Battié MC, Wang Y. Lumbar disc herniation in juveniles: a case–control study of MRI characteristics and etiological insights. J Orthop Res. December 2023;41(12):2685-2693.
2002	Boos N, Weissbach S, Rohrbach H, Weiler C, Spratt KF, Nerlich AG. Classification of age-related changes in lumbar intervertebral discs. Spine. December 1, 2002;27(23):2631-2644.
2006	Adams MA, Roughley PJ. What is intervertebral disc degeneration, and what causes it? Spine. August 15, 2006;31(18):2151-2161.
2015	Colloca C. Biomechanical Evaluation of a Cervical Intervertebral Disc Degeneration Model [PhD thesis]. Arizona State University; December 2015.
2015	Jackman TM. Prediction of Vertebral Fractures Under Axial Compression and Anterior Flexion [PhD thesis]. Boston University; 2015.
2016	DelMonaco AM. Quantifying the Spatial Distribution of Intradiscal Pressure and Its Assessment Via Non-Invasive Estimates of Intervertebral Disc Degeneration [Master's thesis]. Boston University; 2016.
2016	Fein P. Associations Between the Spatial Distribution of Bone Density in the Vertebra and Intervertebral Disc Health [Master's thesis]. Boston University; 2016.
2015	Walter BA. The Role of Inflammation in Intervertebral Disc Degeneration [PhD thesis]. New York, NY: The City College of New York; 2015.
2016	Cisewski SE. Nutrient Related Mechanisms of Intervertebral Disc Degeneration [PhD thesis]. Clemson, SC: Clemson University; August 2016.
2022	Jacobsen TD. Relationship Between Inflammatory Stimulation and Cell Biomechanics in Intervertebral Disc Degeneration [PhD thesis]. Columbia University; 2022.
2018	Mojica Santiago JA. Tissue Engineering of Cervical Intervertebral Discs: An in Vitro and in Vivo Pre-Clinical Canine Model of Total Disc Replacement [PhD thesis]. Ithaca, NY: Cornell University; August 2018.
2020	Sloan SR Jr. Tissue-Engineered Annulus Fibrosus Repair and Nucleus Pulposus Augmentation in Pre-Clinical Models of Intervertebral Disc Degeneration [PhD thesis]. Ithaca, NY: Cornell University; May 2020.
2013	Jamison D IV. Mechanical Characterization of the Human Lumbar Intervertebral Disc Subjected to Impact Loading Conditions [PhD thesis]. Drexel University; August 2013.
2020	Ashinsky BG. Multiscale and Multimodal Structure-Function Analysis of Intervertebral Disc Degeneration and Regeneration [PhD thesis]. Drexel University; May 2020.
2020	Widmer J. Patient Specific Material Mapping for Functional Outcome Prediction and Planning in Spinal Surgery [PhD thesis]. Swiss Federal Institute of Technology Zürich; 2020.
2020	El-Monajjed K. Implementation of a Virtual Reality Module for Gaining Surgical Access Via Planned Oblique Lateral Lumbar Interbody Fusion [PhD thesis]. McGill University; December 2020.
2016	Zhu Q. Numerical Modeling of Intervertebral Disc Degeneration and Repair [PhD thesis]. University of Miami; May 2016.
2020	Baldoni M. Computational Analysis of the Lumbar Spine Kinetics [PhD thesis]. University of Miami; August 2020.
2021	DiStefano TJ. Engineering an Injectable HMSC-Exosome-Laden Hydrogel for Biologically Active Annulus Fibrosus Repair [PhD thesis]. Icahn School of Medicine at Mount Sinai; April 2021.
2022	Gallate ZS. Galectin-3 Mediates Advanced Glycation Endproduct-Induced Collagen Damage in Intervertebral Discs [Master's thesis]. Icahn School of Medicine at Mount Sinai; 2022.
2009	Chagnon A. Étude biomécanique de la dégénérescence du disque intervertébral à l'aide d'un modèle éléments finis poroélastique [Master's thesis]. École polytechnique de Montréal; December 2009.
2011	Gervais J. Lien entre les pathologies rachidiennes et l'intensité de signal IRM dans le disque intervertébral [Master's thesis]. École polytechnique de Montréal; December 2011.
2010	Holguin N. Low-Level Vibrations Maintain the Intervertebral Disc During Unloading [PhD thesis]. Stony Brook, NY: Stony Brook University; December 2010.
2019	McGivern K. Ex Vivo Evaluation of Intervertebral Disc Mechanics Using Diffusion Weighted Imaging on the 7 T MR: Effect of Degeneration [Master's thesis]. Vancouver, BC: University of British Columbia; May 2019.
2020	Figueroa LA. Quantifying in Vivo Cervical Spine Kinematics: Validation of a Novel Data Collection and Processing Pipeline [Master's thesis]. Calgary, AB: University of Calgary; July 2020.
2008	Schultz DS. Structure-Function Relationships in Soft Tissue Mechanics: Examining How the Micro-Scale Architecture of Biochemical Constituents Effects Health [PhD thesis]. Berkeley, CA: Berkeley, University of California; 2008.
2019	Bezci SE. Time-Dependent Characterization of Fluid Flow Into the Intervertebral Disc [PhD thesis]. Berkeley, CA: Berkeley, University of California; 2019.
2019	Yang B. Simulating Intervertebral Disc Mechanics Using Finite Element Method [PhD thesis]. Berkeley, CA: Berkeley, University of California; 2019.
2017	Berry DB. Non-Invasive Measurements of Muscle Microstructure Using Diffusion Tensor Imaging in Active-Duty Marines [PhD thesis]. San Diego (UCSD), University of California; 2017.
2009	Blumenkrantz G. Characterizing Magnetic Resonance Relaxation Times in the Extracellular Matrix in Osteoarthritis and Degenerative Disc Disease [PhD thesis]. San Francisco, University of California; 2009.
2010	Rodriguez AG. Human Endplate Permeability and Microstructure and Their Relationship to Disc Degeneration [PhD thesis]. San Francisco, University of California; 2010.
2011	Cheng KK-W. Diminished Matrix in Pathologic Intervertebral Discs and Tissue Engineered Solutions [PhD thesis]. San Francisco, University of California; 2011.
2013	Laws CJ. Mechanisms of Disc Herniation in Astronauts Following Spaceflight [PhD thesis]. San Francisco, University of California; 2013.
2017	Berg-Johansen B. Characterization of the Spinal Disc-Vertebra Interface and Its Relation to Injury and Back Pain [PhD thesis]. San Francisco, University of California; 2017.
2017	Ouyang A. Effects of Design Factors and Microenvironment on Mesenchymal Stem Cells and Nucleus Pulposus Cells for Intervertebral Disc Tissue Engineering [PhD thesis]. San Francisco, University of California; 2017.
2021	Iriondo C. Characterizing Phenotypes of Musculoskeletal Degeneration Using Medical Imaging and Deep Learning [PhD thesis]. San Francisco, University of California; 2021.
2006	Johannessen W. Nucleus Pulposus Degeneration and Its Role in Intervertebral Disc Mechanical Function [PhD thesis]. Philadelphia, PA: University of Pennsylvania; 2006.
2009	O'Connell GD. Degeneration Affects the Structural and Tissue Mechanics of the Intervertebral Disc [PhD thesis]. Philadelphia, PA: University of Pennsylvania; 2009.
2014	Jacobs NT. Validation and Application of an Intervertebral Disc Finite Element Model Utilizing Independently Constructed Tissue-Level Constitutive Formulations That Are Nonlinear, Anisotropic, and Time-Dependent [PhD thesis]. Philadelphia, PA: University of Pennsylvania; 2014.
2014	Yoder JH. Intervertebral Disc Structure and Mechanical Function Under Physiological Loading Quantified Non-Invasively Utilizing MRI and Image Registration [PhD thesis]. Philadelphia, PA: University of Pennsylvania; 2014.
2015	Martin JT. Nanofibrous Disc-Like Angle Ply Structures for Total Disc Replacement in a Small Animal Model [PhD thesis]. Philadelphia, PA: University of Pennsylvania; 2015.
2015	Showalter BL. The Role of the Nucleus Pulposus in Human Intervertebral Disc Mechanical Function Quantified by Mechanical Loading and Non-Invasive Imaging [PhD thesis]. Philadelphia, PA: University of Pennsylvania; 2015.
2008	Gorapalli D. Evaluation of a PGLcNAc-Derived Material as an Activator of Intervertebral Disc Tissue Repair [Master's thesis]. University of Toronto; 2008.
2008	Moss IL. Modified-Hyaluronan and Elastin-Like Polypeptide Composite Material for Tissue Engineering of the Nucleus Pulposus [Master's thesis]. University of Toronto; 2008.
2010	Leckie AE. Mechanical Evaluation of a Thiol-Modified Hyaluronan Elastin-Like Polypeptide Nucleus Pulposus Replacement Material in Porcine Intervertebral Discs [Master's thesis]. University of Toronto; 2010.
2007	Scannell JP. In Vitro and in Vivo Biomechanical Investigation of the Clinical Practice of Disc Prolapse Prevention and Rehabilitation [PhD thesis]. University of Waterloo; 2007.
2016	Balkovec C. Intervertebral Disc Height Loss and Restoration: Outcomes and Implications [PhD thesis]. University of Waterloo; 2016.
2018	Gruevski KM. The Aging Spine: The Effect of Cyclic Loading, Simulated Degeneration and Prolonged Sitting on Joint Stiffness Across Age [PhD thesis]. University of Waterloo; 2018.
2019	Weber CIK. Structural and Tissue-Level Adaptations of Lumbar Intervertebral Discs in Humans With Inducible Low Back Pain Symptoms [PhD thesis]. St. Louis, MO: Washington University in St. Louis; December 2019.
2021	Aboytes DA. Analysis of Time-Dependent Adaptations of Lumbar Intervertebral Disc Morphology During Standing-Induced Symptoms of Low Back Pain [Master's thesis]. St. Louis, MO: Washington University in St. Louis; August 2021.
2021	Speer JE. Engineering Nucleus Pulposus Cell-Matrix Interactions With Laminin Ligands for Tissue Regeneration [PhD thesis]. St. Louis, MO: Washington University in St. Louis; May 2021.