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MRI-Based Grading Systems for Assessing Lumbar Disc Degeneration: A Scoping Review
Dean Esposito1, Benjamin Brown1, Mark Jonathan Hancock1
1Faculty of Medicine, Health and Human Sciences, Macquarie University Sydney Australia.
JOR Spine
|September 17, 2025
Summary
This scoping review identified 93 magnetic resonance imaging (MRI) grading systems for lumbar disc degeneration (DD). The Pfirrmann method was most common, but sensitivity to change was rarely assessed, highlighting variability in DD assessment.
Area of Science:
- Radiology
- Orthopedics
- Spinal Imaging
Background:
- Numerous magnetic resonance imaging (MRI) grading systems exist for lumbar disc degeneration (DD).
- Current understanding of the most frequently used systems and their application in research is limited.
- Lack of standardization may impact the interpretation of DD-related findings.
Purpose of the Study:
- To comprehensively describe MRI-based grading systems for lumbar DD.
- To identify which systems have been evaluated for measurement properties like reliability, validity, and sensitivity to change.
Main Methods:
- A scoping review methodology was employed.
- Searches were conducted across EMBASE, Medline, and CINAHL databases.
- Data extraction focused on grading system descriptions, application, and assessed measurement properties.
Main Results:
- A total of 93 distinct DD grading systems were identified across 569 studies.
- The Pfirrmann method was the most frequently reported system, utilized in over 50% of studies.
- Commonly assessed features included disc signal intensity (DSI) and disc height (DH); sensitivity to change was rarely evaluated.
Conclusions:
- A high volume of diverse DD grading systems exists, with many used infrequently.
- Variability in MRI assessment methods and data synthesis may influence the reported association between DD and low back pain (LBP).
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