➢ Several different radiographic grading systems for lumbar disc degeneration have been developed; however, none of these systems have been established as a single standard by the spine community.
➢ There is a general consensus regarding the standard for evaluating disc degeneration with use of magnetic resonance imaging (MRI); however, many systems continue to be developed and used, complicating comparisons among studies.
➢ Although of limited clinical application, histological analysis is the most sensitive measure of disc degeneration, particularly for early-stage degenerative changes.
➢ Few studies have assessed radiographic or MRI-based lumbar disc degeneration grading systems by comparing the results against histological measurements.
➢ Studies focusing on the reliability and standardization of imaging techniques for the evaluation of disc degeneration will provide useful data for clinicians and researchers alike.
Low back pain affects >54 million patients annually in the United States alone1. Many patients initially consult general practitioners or orthopaedic surgeons who do not specialize in spine care1. Therefore, knowledge of diagnostic methods for low back pain, including their limitations, may serve as an invaluable tool for all physicians. Imaging is routinely used for the diagnosis of low back pain, with radiographs reportedly being used for 12% (n = 16,567)2 to 31% (n = 17,148)3 of patients and magnetic resonance imaging (MRI) being used for 16% (n = 17,148)3 to 21% (n = 13,760)4 of patients. For the diagnosis of disorders associated with disc degeneration, a variety of grading systems involving both radiographs and MRI have been developed. Different grading systems have been proposed for research and clinical purposes. However, rather than quantifying disc degeneration, these measurements are often combined with subjective clinical symptoms for the purpose of making treatment decisions.
The major limitation of spinal imaging is the poor correlation between …