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How should we grade lumbar disc herniation and nerve root compression? A systematic review
Yiping Li1, Vance Fredrickson, Daniel K Resnick
1Department of Neurological Surgery, University of Wisconsin Medical School, K4/834 CSC, 600 Highland Avenue, Madison, WI, 53792-0001, USA.
Clinical Orthopaedics and Related Research
|May 15, 2014
Summary
Accurate lumbar disc terminology is crucial for patient care. The Combined Task Force (CTF) and van Rijn systems offer reliable classification for lumbar disc herniation and nerve root compression, though "disc bulges" remain confusing.
Area of Science:
- Radiology
- Neurosurgery
- Orthopedics
Background:
- MRI is the standard for evaluating disc-neural structure relationships.
- Inconsistent terminology for lumbar disc herniation and nerve root compression causes confusion.
- Standardized nomenclature is vital for clinical care and research.
Purpose of the Study:
- To systematically review and describe lumbar disc terminology.
- To assess the reliability of different nomenclature systems in clinical practice.
Main Methods:
- Literature search of PubMed using MeSH terms: "Magnetic Resonance Imaging and Intervertebral Disc Displacement", "Lumbar Vertebrae", and "nomenclature", "grading", or "classification".
- Analysis of ten papers evaluating lumbar disc herniation/nerve root compression with grading criteria and interobserver agreement data.
Main Results:
- The Combined Task Force (CTF) and van Rijn classification systems are most reliable for lumbar disc herniation and nerve root compression, respectively.
- The CTF system classifies discs as normal, focal protrusion, broad-based protrusion, or extrusion, excluding "disc bulges".
- The van Rijn system simplifies nerve root compression into "no compression" and "compression" categories.
Conclusions:
- Reliable nomenclature systems exist, but the term "disc bulges" creates confusion and disagreement.
- Correlating imaging findings with clinical presentation is key for managing lumbar disc disease.
- Further research should explore the clinical application of established nomenclature systems.
