MR Image–based Grading of Lumbar Nerve Root Compromise due to Disk Herniation: Reliability Study with Surgical Correlation

Pfirrmann, Christian W. A.; Dora, Claudio; Schmid, Marius R.; Zanetti, M.; Hodler, Juerg; Boos, Norbert

doi:10.1148/radiol.2302021289

Cited by 211 publications

(157 citation statements)

References 20 publications

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“…Women's higher symptom ratings can probably not be explained by pathoanatomical differences. An MRI study by Pfirrmann et al [29] found nerve root compromise equally distributed between the sexes, and Jensen et al [18] reported more nerve root compromise among men than in women. Our findings are in line with previous research showing that women show higher sensitivity to experimental pain [11,31] and report higher pain intensity than men in various clinical conditions [32,37].…”

Section: Discussionmentioning

confidence: 99%

The bothersomeness of sciatica: patients’ self-report of paresthesia, weakness and leg pain

et al. 2009

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The objective of the study was to investigate how patients with sciatica due to disc herniation rate the bothersomeness of paresthesia and weakness as compared to leg pain, and how these symptoms are associated with socio-demographic and clinical characteristics. A crosssectional study was conducted on 411 patients with clinical signs of radiculopathy. Items from the Sciatica Bothersomeness Index (0 = none to 6 = extremely) were used to establish values for paresthesia, weakness and leg pain. Associations with socio-demographic and clinical variables were analyzed by multiple linear regression. Mean scores (SD) were 4.5 (1.5) for leg pain, 3.4 (1.8) for paresthesia and 2.6 (2.0) for weakness. Women reported higher levels of bothersomeness for all three symptoms with mean scores approximately 10% higher than men. In the multivariate models, more severe symptoms were associated with lower physical function and higher emotional distress. Muscular paresis explained 19% of the variability in self-reported weakness, sensory findings explained 10% of the variability in paresthesia, and straight leg raising test explained 9% of the variability in leg pain. In addition to leg pain, paresthesia and weakness should be assessed when measuring symptom severity in sciatica.

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Section: Discussionmentioning

confidence: 99%

The bothersomeness of sciatica: patients’ self-report of paresthesia, weakness and leg pain

et al. 2009

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“…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.…”

Section: Straight Leg Raising Test (Slr) a Validated Measure With A mentioning

confidence: 99%

“…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.…”

Section: Image Analysismentioning

confidence: 99%

“…Subarticular nerve compression was assessed using the modification of a system described by Pfirmann et al [11,18]. Grade I applied when the disc simply contacted the nerve root, Grade II when the nerve root was displaced but with preservation of periradicular cerebrospinal fluid (CSF) or fat, Grade III when the periradicular CSF or fat was obliterated, and Grade IV when the nerve root was morphologically distorted.…”

Section: Nerve Compressionmentioning

confidence: 99%

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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

Ekedahl

Jönsson

Annertz

et al. 2016

BMR

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Abstract. BACKGROUND:Transforaminal epidural steroid injection (TESI) is a frequently used intervention for lumbar radicular pain. OBJECTIVE: To evaluate the value of MRI findings, neurologic assessment and the Slump test (neurodynamic test) as predictors of treatment response to TESI. METHOD: One hundred subjects (mean age 58 [SD13], 54% females) were included in this trial. The sample was stratified by location of disc herniaton, grade of nerve root compression, clinically assessed neurologic deficit and positive Slump test. Treatment response was primarily evaluated by Visual Analogue Scale for leg pain after three weeks. Predictive value for each stratum was analyzed using logistic regression after the sample was dichotomized into definite treatment response ( 50% reduction of pain) and negative response ( 0% reduction) to TESI (the 1-49% reduction group was excluded). RESULTS: The overall definite treatment response rate was 27%. The Slump test was the only predictor of the response to TESI (p = 0.031). The definite treatment response rates for subjects with positive and negative Slump test were 33% and 15%, respectively. CONCLUSION: In patients with chronic low back related leg pain, MRI findings and neurologic assessment results failed to predict treatment response, whereas a positive Slump test predicted the best 3-week response to TESI.

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“…According to nomenclature of North American Spine Society (NASS), the grading system of Pfirrmann and the physical examination rules for conscription in the Republic of Korea, which provide information on relations between the nerve root and the protruding disc, each of the four independent radiologists provided a grade from 1 to 5 by reviewing MRI, MRM, and myelography 7,16,17) . Grade 1 was regarded as minimal root irritation, indicating disc bulging or protrusion without root irritation.…”

Section: Radiological Factorsmentioning

confidence: 99%

Comparative Study of Lumbar Magnetic Resonance Imaging and Myelography in Young Soldiers with Herniated Lumbar Disc

Kang

Choi

Seong

et al. 2010

J Korean Neurosurg Soc

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Objective : This study was undertaken to compare the diagnostic performances of magnetic resonance imaging (MRI), MR myelography (MRM) and myelography in young soldiers with a herniated lumbar disc (HLD). Methods : Sixty-five male soldiers with HLD comprised the study cohort. A visual analogue scale for low back pain (VAS-LBP), VAS for leg radiating pain (VAS-LP), and Oswestry disability index (ODI) were applied. Lumbar MR, MRM, and myelographic findings were checked and evaluated by four independent radiologists, respectively. Each radiologist was asked to score (1 to 5) the degree of disc protrusion and nerve root compression using modified grading systems devised by the North American Spine Society and Pfirrmann and the physical examination rules for conscription in the Republic of Korea. Correlated coefficients between clinical and radiological factors were calculated. Interpretational reproducibility between MRI and myelography by four bases were calculated and compared. Results : Mean patient age was 20.5 ± 1.1. Mean VAS-LBP and VAS-LP were 6.7 ± 1.6 and 7.4 ± 1.7, respectively. Mean ODI was 48.0 ± 16.2%. Mean MRI, MRM, and myelography scores were 3.3 ± 0.9, 3.5 ± 1.0, and 3.9 ± 1.1, respectively. All scores of diagnostic performances were significantly correlated (p < 0.05). However, none of these scores reflected the severity of patients' symptoms. There was no statistical difference of interpretational reproducibility between MRI and myelography. Conclusion : Although MRI and myelography are based on different principles, they produce similar interpretational reproducibility in young soldiers with a HLD. However, these modalities do not reflect the severity of symptoms.

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MR Image–based Grading of Lumbar Nerve Root Compromise due to Disk Herniation: Reliability Study with Surgical Correlation

Cited by 211 publications

References 20 publications

The bothersomeness of sciatica: patients’ self-report of paresthesia, weakness and leg pain

The bothersomeness of sciatica: patients’ self-report of paresthesia, weakness and leg pain

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

Comparative Study of Lumbar Magnetic Resonance Imaging and Myelography in Young Soldiers with Herniated Lumbar Disc

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