Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

Magnetic Resonance Imaging Grading Systems for Central Canal and Neural Foraminal Stenoses of the Lumbar and Cervical Spines With a Focus on the Lee Grading System

  • Jiwoon Seo (Department of Radiology, Seoul National University College of Medicine) ;
  • Joon Woo Lee (Department of Radiology, Seoul National University College of Medicine)
  • Received : 2022.05.29
  • Accepted : 2022.12.19
  • Published : 2023.03.01
Download PDF
⟨ Previous Next ⟩

Abstract

Magnetic resonance imaging (MRI) is a standard imaging modality for diagnosing spinal stenosis, which is a common degenerative disorder in the elderly population. Standardized interpretation of spinal MRI for diagnosing and grading the severity of spinal stenosis is necessary to ensure correct communication with clinicians and to conduct clinical research. In this review, we revisit the Lee grading system for central canal and neural foraminal stenosis of the cervical and lumbar spine, which are based on the pathophysiology and radiologic findings of spinal stenosis.

Keywords

References

  1. Jensen RK, Jensen TS, Koes B, Hartvigsen J. Prevalence of lumbar spinal stenosis in general and clinical populations: a systematic review and meta-analysis. Eur Spine J 2020;29:2143-2163
  2. Statistics of annual lumbar magnetic resonance imaging in south korea 2010-2021. Healthcare Bigdata Hub.com Web site. http://opendata.hira.or.kr/op/opc/olapDiagBhvInfo.do. Accessed April 11, 2022
  3. Andreisek G, Hodler J, Steurer J. Uncertainties in the diagnosis of lumbar spinal stenosis. Radiology 2011;261:681-684
  4. Genevay S, Atlas SJ, Katz JN. Variation in eligibility criteria from studies of radiculopathy due to a herniated disc and of neurogenic claudication due to lumbar spinal stenosis: a structured literature review. Spine (Phila Pa 1976) 2010;35:803-811
  5. Kreiner DS, Shaffer WO, Baisden JL, Gilbert TJ, Summers JT, Toton JF, et al. An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis (update). Spine J 2013;13:734-743
  6. Lee GY, Lee JW, Choi HS, Oh KJ, Kang HS. A new grading system of lumbar central canal stenosis on MRI: an easy and reliable method. Skeletal Radiol 2011;40:1033-1039
  7. Lee S, Lee JW, Yeom JS, Kim KJ, Kim HJ, Chung SK, et al. A practical MRI grading system for lumbar foraminal stenosis. AJR Am J Roentgenol 2010;194:1095-1098
  8. Kang Y, Lee JW, Koh YH, Hur S, Kim SJ, Chai JW, et al. New MRI grading system for the cervical canal stenosis. AJR Am J Roentgenol 2011;197:W134-W140
  9. Kim S, Lee JW, Chai JW, Yoo HJ, Kang Y, Seo J, et al. A new MRI grading system for cervical foraminal stenosis based on axial T2-weighted images. Korean J Radiol 2015;16:1294-1302
  10. The Merriam-Webster Dictionary [Internet]. Springfield (MA): Merriam-Webster Inc., 2022. Stenosis. https://www.merriam-webster.com/dictionary/stenosis
  11. Mates RE, Gupta RL, Bell AC, Klocke FJ. Fluid dynamics of coronary artery stenosis. Circ Res 1978;42:152-162
  12. Roy M, Sikarwar BS, Bhandwal M, Ranjan P. Modelling of blood flow in stenosed arteries. Procedia Computer Science 2017;115:821-830
  13. Telano LN, Baker S. Physiology, cerebral spinal fluid [Internet] [Last updated Jul 4, 2022]. Treasure Island (FL): StatPearls Publishing, 2022. https://www.ncbi.nlm.nih.gov/books/NBK519007
  14. Hasue M, Kikuchi S, Sakuyama Y, Ito T. Anatomic study of the interrelation between lumbosacral nerve roots and their surrounding tissues. Spine (Phila Pa 1976) 1983;8:50-58
  15. Jenis LG, An HS. Spine update: Lumbar foraminal stenosis. Spine (Phila Pa 1976) 2000;25:389-394
  16. Choi YK. Lumbar foraminal neuropathy: an update on nonsurgical management. Korean J Pain 2019;32:147-159
  17. Andreisek G, Deyo RA, Jarvik JG, Porchet F, Winklhofer SF, Steurer J, et al. Consensus conference on core radiological parameters to describe lumbar stenosis - an initiative for structured reporting. Eur Radiol 2014;24:3224-3232
  18. Genevay S, Atlas SJ. Lumbar spinal stenosis. Best Pract Res Clin Rheumatol 2010;24:253-265
  19. Steurer J, Roner S, Gnannt R, Hodler J; LumbSten Research Collaboration. Quantitative radiologic criteria for the diagnosis of lumbar spinal stenosis: a systematic literature review. BMC Musculoskelet Disord 2011;12:175
  20. Cohen MS, Wall EJ, Kerber CW, Abitbol JJ, Garfin SR. The anatomy of the cauda equina on CT scans and MRI. J Bone Joint Surg Br 1991;73:381-384
  21. Lohman CM, Tallroth K, Kettunen JA, Lindgren KA. Comparison of radiologic signs and clinical symptoms of spinal stenosis. Spine (Phila Pa 1976) 2006;31:1834-1840
  22. Sirvanci M, Bhatia M, Ganiyusufoglu KA, Duran C, Tezer M, Ozturk C, et al. Degenerative lumbar spinal stenosis: correlation with Oswestry Disability Index and MR imaging. Eur Spine J 2008;17:679-685
  23. Ko YJ, Lee E, Lee JW, Park CY, Cho J, Kang Y, et al. Clinical validity of two different grading systems for lumbar central canal stenosis: Schizas and Lee classification systems. PLoS One 2020;15:e0233633
  24. Park HJ, Kim SS, Lee YJ, Lee SY, Park NH, Choi YJ, et al. Clinical correlation of a new practical MRI method for assessing central lumbar spinal stenosis. Br J Radiol 2013;86:20120180
  25. Lisanti C, Carlin C, Banks KP, Wang D. Normal MRI appearance and motion-related phenomena of CSF. AJR Am J Roentgenol 2007;188:716-725
  26. Schizas C, Theumann N, Burn A, Tansey R, Wardlaw D, Smith FW, et al. Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images. Spine (Phila Pa 1976) 2010;35:1919-1924
  27. Hasegawa T, An HS, Haughton VM, Nowicki BH. Lumbar foraminal stenosis: critical heights of the intervertebral discs and foramina. A cryomicrotome study in cadavera. J Bone Joint Surg Am 1995;77:32-38
  28. Wildermuth S, Zanetti M, Duewell S, Schmid MR, Romanowski B, Benini A, et al. Lumbar spine: quantitative and qualitative assessment of positional (upright flexion and extension) MR imaging and myelography. Radiology 1998;207:391-398
  29. Kunogi J, Hasue M. Diagnosis and operative treatment of intraforaminal and extraforaminal nerve root compression. Spine (Phila Pa 1976) 1991;16:1312-1320
  30. Park HJ, Kim SS, Lee SY, Park NH, Rho MH, Hong HP, et al. Clinical correlation of a new MR imaging method for assessing lumbar foraminal stenosis. AJNR Am J Neuroradiol 2012;33:818-822
  31. Jeong TS, Ahn Y, Lee SG, Kim WK, Son S, Kwon JH. Correlation between MRI grading system and surgical findings for lumbar foraminal stenosis. J Korean Neurosurg Soc 2017;60:465-470
  32. Ferrara LA. The biomechanics of cervical spondylosis. Adv Orthop 2012;2012:493605
  33. Choi SH, Kang CN. Degenerative cervical myelopathy: pathophysiology and current treatment strategies. Asian Spine J 2020;14:710-720
  34. Edwards WC, LaRocca H. The developmental segmental sagittal diameter of the cervical spinal canal in patients with cervical spondylosis. Spine (Phila Pa 1976) 1983;8:20-27
  35. Pavlov H, Torg JS, Robie B, Jahre C. Cervical spinal stenosis: determination with vertebral body ratio method. Radiology 1987;164:771-775
  36. Muhle C, Metzner J, Weinert D, Falliner A, Brinkmann G, Mehdorn MH, et al. Classification system based on kinematic MR imaging in cervical spondylitic myelopathy. ANJR Am J Neuroradiol 1998;19:1763-1771
  37. Park HJ, Kim SS, Chung EC, Lee SY, Park NH, Rho MH, et al. Clinical correlation of a new practical MRI method for assessing cervical spinal canal compression. AJR Am J Roentgenol 2012;199:W197-W201
  38. Joaquim AF, Baum GR, Tan LA, Riew KD. Dynamic cord compression causing cervical myelopathy. Neurospine 2019;16:448-453
  39. Abbed KM, Coumans JV. Cervical radiculopathy: pathophysiology, presentation, and clinical evaluation. Neurosurgery 2007;60(1 Suppl 1):S28-S34
  40. Bartlett RJ, Hill CR, Gardiner E. A comparison of T2 and gadolinium enhanced MRI with CT myelography in cervical radiculopathy. Br J Radiol 1998;71:11-19
  41. Park HJ, Kim SS, Han CH, Lee SY, Chung EC, Kim MS, et al. The clinical correlation of a new practical MRI method for grading cervical neural foraminal stenosis based on oblique sagittal images. AJR Am J Roentgenol 2014;203:412-417
  42. Simpson AK, Sabino J, Whang P, Emerson JW, Grauer JN. The assessment of cervical foramina with oblique radiographs: the effect of film angle on foraminal area. J Spinal Disord Tech 2009;22:21-25
  43. Lee JE, Park HJ, Lee SY, Lee YT, Kim YB, Lee KH, et al. Interreader reliability and clinical validity of a magnetic resonance imaging grading system for cervical foraminal stenosis. J Comput Assist Tomogr 2017;41:926-930
  44. Lee KH, Park HJ, Lee SY, Chung EC, Rho MH, Shin H, et al. Comparison of two MR grading systems for correlation between grade of cervical neural foraminal stenosis and clinical manifestations. Br J Radiol 2016;89:20150971