🦴 Spine Grading: Pfirrmann / Modic / Meyerding
UseStandardized grading for spine MRI/radiograph reports: disc degeneration, endplate marrow change type, and sl…
SourcePfirrmann CW, et al. MR classification of lumbar intervertebral disc degeneration. Spine 2001;26:18…
This-shift next steps
After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.
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Methodology · worked example, guidelines & full notes
Pfirrmann: I normal; II–III early; IV–V advancing/end-stage. Grade I hinges on NP homogeneity; III→IV on loss of NP/annulus distinction.
When to use
Standardized grading for spine MRI/radiograph reports: disc degeneration, endplate marrow change type, and slip severity.
How it works
Pfirrmann I–V (homogeneity / NP-annulus distinction / T2 signal / height). Modic: I = T1 hypo, T2 hyper (edema); II = T1 hyper, T2 hyper or iso (fat); III = T1 hypo, T2 hypo (sclerosis). Meyerding: I 0–25%, II 25–50%, III 50–75%, IV 75–100%, V >100% (spondyloptosis).
Key points
- Pfirrmann: I normal; II–III early; IV–V advancing/end-stage. Grade I hinges on NP homogeneity; III→IV on loss of NP/annulus distinction.
- Modic I (T1 hypo, T2 hyper) correlates relatively more with active pain and instability.
- Modic II (T1 hyper, T2 hyper/iso) is the most common and relatively stable; III (T1 hypo, T2 hypo) is subchondral sclerosis.
- Meyerding: 25% per grade, >100% = spondyloptosis; I–II low-grade, III–V high-grade (50% divide).
References
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Grading system | Modic (endplate/marrow change) |
|---|---|
| Pfirrmann grade (signal / NP-annulus distinction / height) | III — inhomogeneous grey, unclear NP/annulus, normal-to-slightly reduced height |
| Modic: T1 signal | Isointense |
| Modic: T2 signal | Isointense |
| Meyerding: percent anterior slip (%; leave blank to use A/B below) | 30 |
| Meyerding: slip distance A (mm, optional) | 6 |
| Meyerding: AP diameter of lower vertebra B (mm, optional) | 30 |
→Modic typeMixed
- Histologic basis：Mixed or atypical
- T1 / T2 signal：T1 iso / T2 iso
- Clinical note：e.g. I/II or II/III mixed, reflecting coexisting stages; correlate with morphology and follow-up.
| Grading system | Pfirrmann (disc degeneration) |
|---|---|
| Pfirrmann grade (signal / NP-annulus distinction / height) | I — homogeneous bright white, clear NP/annulus, normal height |
| Modic: T1 signal | Hypointense |
| Modic: T2 signal | Hypointense |
| Meyerding: percent anterior slip (%; leave blank to use A/B below) | 30 |
| Meyerding: slip distance A (mm, optional) | 6 |
| Meyerding: AP diameter of lower vertebra B (mm, optional) | 30 |
→Pfirrmann gradeGrade I
- Degeneration stage：Normal disc (I normal; II–III early; IV–V advancing/end-stage)
- Features：Homogeneous, bright white (well-hydrated), clear NP/annulus distinction, normal height.
- Reading tips：Sagittal T2. Grade I hinges on NP homogeneity; the III→IV step hinges on loss of the NP/annulus distinction.
Verification & sources · governance
FAQ
Frequently asked questions
- What are the limits and cautions when using Spine Grading: Pfirrmann / Modic / Meyerding?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- Does Spine Grading: Pfirrmann / Modic / Meyerding upload patient data? Where is it calculated?
- Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.
- How is Spine Grading: Pfirrmann / Modic / Meyerding calculated in practice? Can you show a worked example?
- Inputs: Grading system Modic (endplate/marrow change), Pfirrmann grade (signal / NP-annulus distinction / height) III — inhomogeneous grey, unclear NP/annulus, normal-to-slightly reduced height, Modic: T1 signal Isointense, Modic: T2 signal Isointense, Meyerding: percent anterior slip (%; leave blank to use A/B below) 30, Meyerding: slip distance A (mm, optional) 6, Meyerding: AP diameter of lower vertebra B (mm, optional) 30 → Result: Modic type Mixed（Histologic basis: Mixed or atypical, T1 / T2 signal: T1 iso / T2 iso, Clinical note: e.g. I/II or II/III mixed, reflecting coexisting stages; correlate with morphology and follow-up.） Inputs: Grading system Pfirrmann (disc degeneration), Pfirrmann grade (signal / NP-annulus distinction / height) I — homogeneous bright white, clear NP/annulus, normal height, Modic: T1 signal Hypointense, Modic: T2 signal Hypointense, Meyerding: percent anterior slip (%; leave blank to use A/B below) 30, Meyerding: slip distance A (mm, optional) 6, Meyerding: AP diameter of lower vertebra B (mm, optional) 30 → Result: Pfirrmann grade Grade I（Degeneration stage: Normal disc (I normal; II–III early; IV–V advancing/end-stage), Features: Homogeneous, bright white (well-hydrated), clear NP/annulus distinction, normal height., Reading tips: Sagittal T2. Grade I hinges on NP homogeneity; the III→IV step hinges on loss of the NP/annulus distinction.）