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Klinische richtlijn rond lage rugpijn en radiculaire pijnPublished by: KCELast published: 2018Guide de pratique clinique pour les douleurs lombaires et radiculairesPublished by: KCELast published: 2018Modic classification of marrow changes on magnetic resonance imaging (MRI)[94]
Type 1: Hypointense on T1-weighted, hyperintense on T2-weighted images. Acute or subacute inflammation.
Type 2: Hyperintense on T1, iso- or hyperintense on T2-weighted images. Chronic changes.
Type 3: Hypointense on T1- and on T2-weighted images. Advanced degenerative changes.
Pfirrmann classification of disc degeneration on MRI[95]
Grading based on T2-weighted mid-sagittal fast spin echo images.
Grade 1: homogeneous disc, hyperintense, normal disc height.
Grade 2: Inhomogeneous, hyperintense, loss of nuclear annular transition, normal disc height, with or without horizontal grey bands.
Grade 3: Inhomogeneous, intermediate grey signal, loss of nuclear annular transition, slightly reduced disc height.
Grade 4: Inhomogeneous, hypointense dark grey, loss of nuclear annular transition, moderate reduction of disc height.
Grade 5: Inhomogeneous, hypointense black, disc space collapsed.
Pathria computed tomographic classification of facet joint arthritis[96]
Grade 0: Normal facet joint 2 to 4 mm width.
Grade 1: Narrowing of the facet joint <2 mm ± small osteophytes ± mild hypertrophy.
Grade 2: Narrow joint space ± moderate osteophytes ± moderate hypertrophy ± mild subarticular bone erosion.
Grade 3: Narrow joint space ± large osteophytes ± severe hypertrophy ± severe subarticular bone erosions ± subchondral cysts.
Endplate classification and score of disc degeneration post MRI[97]
1: No damage, symmetrically concave, hypointense band, no Modic changes.
2: Focal thinning at centre or periphery, no endplate (EP) break, no Modic changes.
3: Focal disc marrow contact, no change in EP contour, no Modic changes.
4: EP damage, Schmorl node up to 25%, subchondral changes present.
5: EP ≤50% width damaged, subchondral changes.
6: Complete EP damage with gross irregularity and sclerosis.
Total score is the addition of the scores for each endplate at each level.
Kirkaldy-Willis radiological degenerative cascade[98]
Stage 1: Segmental dysfunction.
Stage 2: Segmental instability (disc collapse).
Stage 3: Restabilisation (advanced degenerative changes).
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