A Practical MRI Grading System for Lumbar Foraminal Stenosis

Abstract

The new grading system for foraminal stenosis of the lumbar spine showed nearly perfect interobserver and intraobserver agreement and would be helpful for clinical study and routine practice.

Three week results of transforaminal epidural steroid injection in patients with chronic unilateral low back related leg pain: The relation to MRI findings and clinical features

“…MR images were analyzed by a well experienced radiologist (MA) using previously published classification systems [1,11,17,18]. The radiologist, who was blinded to all clinical information but the level of TESI, firstly, analyzed if DH existed, secondly, the type of DH (protrusion or extrusion), thirdly, the location of DH (central, subarticular, foraminal and extraforaminal) according to Fardon and Milette [19] and finally, the grade of nerve compression according to Pfirmann et al [1,11,18]. The subjects were classified as: no DH (n = 15), protrusion (n = 57) and extrusion (n = 27), and as: central (n = 15), subarticular (n = 45), foraminal (n = 18) and extraforaminal (n = 6) DH.…”

“…Foraminal nerve compression was assessed using a system introduced by Lee et al [1]. Grade I applied when perineural fat was obliterated in two opposing directions (vertical or transverse), Grade II when perineural fat was obliterated in four directions without morphologic distortion of the nerve root, and Grade III when distortion or other morphologic change in the nerve root was evident.…”

“…All MRI assessments, clinical tests and self-reported outcomes have shown adequate reliability previously [1,11,18,26,28,29]. Thus, an inter-rater reliability evaluation was not performed in this study.…”

“…Transforaminal epidural steroid injection (TESI) is a frequently used intervention for lumbar radicular pain, a syndrome commonly caused by disc herniation (DH) or foraminal stenosis [1]. Effectiveness of TESI in reducing leg pain has been determined with a maximum effect within one month after injection and then a gradual deterioration of outcome [2].…”

Clinical Correlation of a New MR Imaging Method for Assessing Lumbar Foraminal Stenosis

“…They focused on the degree of epidural fat obliteration but did not consider direct nerve root compression or deformity. Recently, Lee et al 3 reported a new grading system for lumbar spinal foraminal stenosis. They considered the type of stenosis, the amount of fat obliteration, and the presence of nerve root compression.…”