Spinal Disease
Management
Conservative
Decompression Without Fusion
Decompression With Fusion
Gender
Male
Female
Occupation
Sedentary
Light
Medium
Heavy
Exercise
No
Yes
Ambulation
Independent
With Support
Bedridden
Chief Complaint
Back
Leg
Back = Leg
Duration of Symptoms
<3months
3-6months
>6months
History Of Past Spine Surgery
No
Yes
Neurological Deficit
No
Yes
Listhesis
No
Yes
Pfirmann Disc Degeneration Grading
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Modic Classification
Type 0
Type 1
Type 2
Type 3
Disc Herniation
Type 1 (Normal Pattern)
Type 2 (Symmetric Disc Bulging)
Type 3 (Disc Protrusion)
Type 4 (Disc Extrusion)
Type 5 (Free Fragment)
Perineural Intraforaminal Fat
Grade 1 (Normal Segments; Normal Dorsolateral Border Of The Intervertebral Disk And Normal Form Of Foraminal Epidural Fat; Oval Or Inverted Pear Shape According To Stephens Et Al)
Grade 2 (Slight Foraminal Stenosis And Deformity Of Epidural Fat And Remaining Fat Still Completely Surrounds Exiting Nerve Root)
Grade 3 (Marked Foraminal Stenosis And Epidural Fat Only Partially Surrounds Nerve Root)
Grade 4 (Advanced Stenosis With Complete Obliteration Of Foraminal Epidural Fat)
Compression of Central Spinal Canal
CSA >100mm2
CSA 75-100mm2
CSA <75mm2
Thickness (Anteroposterior) Of Ligamentum Flavum
< 2mm
2-4mm
>4mm<75mm2
Nerve Root Compression In Lateral Recess
Grade 0 (No Lateral Recess Narrowing Or Root Compression)
Grade 1 (Evidence Of Lateral Recess Narrowing But No Objective Evidence Of Root Compression)
Grade 2 (More Significant Lateral Recess Narrowing (Angular Or Trefoil) With Nerve Root Judged To Be Flattened Or Widened But With Preservation Of CSF Around Root In Recess)
Grade 3 (Severe Nerve Root Compression Within Lateral Recess With Obliteration Of CSF From Recess)
Hypertrophic Facet Joint Degeneration
Grade 0 (No degeneration: Normal)
Grade 1 (Mild Degeneration: Narrowing Of Facet Joint)
Grade 2 (Moderate Degeneration: Narrowing Plus Sclerosis Or Hypertrophy)
Grade 3 (Severe Degeneration: Narrowing, Sclerosis, And Osteophytes)
Foraminal Nerve Root Impingement
None
Touching
Displacing
Compressing
Size And Shape Of Formenn
Grade 1 (Normal: Foramina must be at least 1 cm high and 5 mm wide; there must be smooth bony walls; perineural fat surrounding nerve root should be clearly seen; presence or absence of abnormalities is not considered)
Grade 2 (Slightly narrow but normal foramina: Foramina are reduced in height to just under 10 mm but should be at least 5 mm wide; when present, osteophytes are always minimal in size and facets are normally aligned in sagittal view)
Grade 3 (Narrow foramen of questionable clinical significance: Foramina are reduced in size more than are grade 2 foramina; some perineural fat can still be seen around nerve on sagittal views)
Grade 4 (Moderately abnormal foramina: Foramina just fit a normal-size nerve and there is no reserve space; prominent osteophyte)