MRI Assessment of Lumbar Intervertebral Disc Degeneration with Lumbar Degenerative Disease Using the Pfirrmann Grading Systems

Abstract

BackgroundTo evaluate by MRI intervertebral disc degeneration in patients with lumbar degenerative disease using the Pfirrmann grading system and to determine whether Modic changes correlated with the Pfirrmann grades and modified Pfirrmann grades of disc degeneration.MethodsThe clinical data of 108 surgical patients with lumbar degenerative disease were reviewed and their preoperative MR images were analyzed. Disc degeneration was evaluated using the Pfirrmann grading system. Patients were followed up and low back pain was evaluated using the visual analog scale (VAS) and the effect of back pain on the daily quality of life was assessed using Oswestry disability index (ODI).ResultsForty-four cases had normal anatomical appearance (Modic type 0) and their Pfirrmann grades were 3.77±0.480 and their modified Pfirrmann grades were of 5.81±1.006. Twenty-seven cases had Modic type I changes and their Pfirrmann grades were 4.79±0.557 and their modified Pfirrmann grades were 7.00±0.832. Thirty-six cases exhibited Modic type II changes and their Pfirrmann grades and modified Pfirrmann grades were 4.11±0.398 and 6.64±0.867, respectively. One case had Modic type III changes. Kruskal-Wallis test revealed significant difference in modified Pfirrmann grade among Modic type 0, I and II changes (P<0.01) but no significant difference between Modic type I and II changes (P>0.05). Binary regression analysis showed that Modic changes correlated most strongly with disc degeneration. Follow up studies indicated that the VAS and ODI scores were markedly improved postoperatively. However, no difference was noted in VAS and ODI scores among patients with different Modic types.ConclusionModic changes correlate with the Pfirrmann and modified Pfirrmann grades of disc degeneration in lumbar degenerative disease. There is no significant correlation between Modic types and surgical outcomes.

The ‘Lumbar Fusion Outcome Score’ (LUFOS): a new practical and surgically oriented grading system for preoperative prediction of surgical outcomes after lumbar spinal fusion in patients with degenerative disc disease and refractory chronic axial low back pain

“…Finally, despite the fact that some studies have demonstrated a positive correlation between the presence of Modic changes and the degree of disc degeneration as measured by the Pfirrmann scale [1,57], we found that the combination of Modic changes and the degree of disc degeneration significantly enhanced the strength of the newly proposed score, and L5/S1 levels (a). No degenerative endplate changes were observed in both levels.…”

“…2). As recent studies have demonstrated no significant correlation between different Modic types and surgical outcomes [57], in the present study we chose to group together Modic type 1 and Modic type 2 changes.…”

Assessment of Intervertebral Disc Degeneration Based on Quantitative Magnetic Resonance Imaging Analysis

“…We used a modified Pfirrmann grading system,[20] which divides IVD degeneration into four grades, according to NP signal intensity, homogeneity, and loss of disc height (Table 1). A board-certified radiologist and a spine fellow analyzed the MR images.…”

“…In the presented study, the NP voxel count of punctured IVDs was correlated to established outcome measures for this rat-tail model: disc height measurements using X-rays[19], qualitative MR imaging based on the modified Pffirmann scale[20] and histological assessments according to the grading system developed by Han B. [15]…”

Facet Orientation and Tropism: Association With Accelerated Degeneration of Stabilizing Structures in Lower Lumbar Spine

“…Inflammatory changes that closely correlate with disc degeneration and are occasionally seen in vertebral endplates, i.e. Modic magnetic resonance imaging (MRI) changes, are also believed to be the possible source of low back pain 38 .…”