Skip to main content
SpringerLink
Log in

A systematic review of validated classification systems for cervical and lumbar spinal foraminal stenosis based on magnetic resonance imaging

  • Review Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

Foraminal stenosis is commonly investigated with radiological methods in patients with radiating pain in extremities. However, there is a lack of consensus regarding the methodology to assess compression of the nerve roots. This systematic review was performed to identify validated classification systems for foraminal stenosis in the lumbar and cervical spine based on magnetic resonance imaging (MRI).

Methods

A systematic search was conducted according to the PRISMA guidelines. The search included Cochrane, Embase, Medline and PubMed databases going back 30 years and up to September 2021. Three categories of words were used in different variations; foraminal stenosis, MRI and scoring. For inclusion, at least one word from each category had to be present. Articles suggesting classification systems or reporting on their validation were selected for inclusion.

Results

A total of 823 articles were identified and all abstracts were reviewed. Subsequently, a full-text review of 64 articles was performed and finally 14 articles were included. A total of three validated classification systems were found for the cervical and lumbar spine. The remaining 11 articles reported on validation or suggested modifications of the classification systems.

Conclusion

The three classification systems demonstrated moderate to good reliability and have all been shown feasible in the clinical setting. There is however a need for further studies testing the validity of these classifications in relation to both clinical findings and to surgical outcome data.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Jenis GL, An SH (2000) Spine update: lumbar foraminal stenosis. Spine 25(3):389–394

    Article  CAS  Google Scholar 

  2. Yousem DM et al (1991) Degenerative narrowing of the cervical spine neural foramina: evaluation with high-resolution 3DFT gradient-echo MR imaging. AJNR Am J Neuroradiol 12(2):229

    CAS  PubMed  PubMed Central  Google Scholar 

  3. McDonald MA et al (2019) ACR Appropriateness criteria cervical neck pain or cervical radiculopathy. J Am Coll Radiol 16(5 Supplement):S57–S76

    Article  Google Scholar 

  4. Patel ND et al (2016) ACR Appropriateness criteria low back pain. J Am Coll Radiol 13(9):1069–1078

    Article  Google Scholar 

  5. Andreisek G et al (2014) Consensus conference on core radiological parameters to describe lumbar stenosis an initiative for structured reporting. Eur Radiol 24(12):3224–3232

    Article  Google Scholar 

  6. Lin HH et al (2019) What is the difference in morphologic features of the lumbar vertebrae between caucasian and taiwanese subjects? A CT-based study: implications of pedicle screw placement via Roy-camille or weinstein method. BMC Musculoskelet Disord 20(1):252

    Article  Google Scholar 

  7. Kintzele L et al (2018) Oblique sagittal images prevent underestimation of the neuroforaminal stenosis grade caused by disc herniation in cervical spine mri. Rofo Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin 190(10):e2

    Article  Google Scholar 

  8. Li Y, Fredrickson V, Resnick DK (2015) How should we grade lumbar disc herniation and nerve root compression? A systematic review. Clin Orthop Relat Res 473(6):1896–1902

    Article  Google Scholar 

  9. Liberati A et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 62(10):e1–e34

    Article  Google Scholar 

  10. Koo TK, Li MY (2016) A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 15(2):155–163

    Article  Google Scholar 

  11. Kim S et al (2015) A new MRI grading system for cervical foraminal stenosis based on axial T2-weighted images. Korean J Radiol 16(6):1294–1302

    Article  Google Scholar 

  12. Park HJ et al (2015) Clinical correlation of a new and practical magnetic resonance grading system for cervical foraminal stenosis assessment. Acta Radiol 56(6):727–732

    Article  Google Scholar 

  13. Kim MS, Lee DG, Chang MC (2018) Outcome of transforaminal epidural steroid injection according to severity of cervical foraminal stenosis. World Neurosurg 110:e398–e403

    Article  Google Scholar 

  14. Park HJ et al (2013) A practical MRI grading system for cervical foraminal stenosis based on oblique sagittal images. Br J Radiol 86(1025):20120515

    Article  Google Scholar 

  15. Park HJ et al (2014) The clinical correlation of a new practical MRI method for grading cervical neural foraminal stenosis based on oblique sagittal images. Am J Roentgenol 203(2):412–417

    Article  Google Scholar 

  16. Lee JE et al (2017) Interreader reliability and clinical validity of a magnetic resonance imaging grading system for cervical foraminal stenosis. J Comput Assist Tomogr 41(6):926–930

    Article  Google Scholar 

  17. Kim W et al (2017) Comparison of MRI grading for cervical neural foraminal stenosis based on axial and oblique sagittal images: concordance and reliability study. Clin Imaging 43:165–169

    Article  Google Scholar 

  18. Lee KH et al (2016) Comparison of two MR grading systems for correlation between grade of cervical neural foraminal stenosis and clinical manifestations. Br J Radiol 89(1062):20150971

    Article  Google Scholar 

  19. McHugh ML (2012) Interrater reliability: the kappa statistic. Biochem Med (Zagreb) 22(3):276–282

    Article  Google Scholar 

  20. Park HJ et al (2012) Clinical correlation of a new MR imaging method for assessing lumbar foraminal stenosis. AJNR Am J Neuroradiol 33(5):818–822

    Article  CAS  Google Scholar 

  21. Lee S et al (2010) A practical MRI grading system for lumbar foraminal stenosis. AJR Am J Roentgenol 194(4):1095–1098

    Article  Google Scholar 

  22. Hofmann UK et al (2020) Interobserver reliability when classifying MR imaging of the lumbar spine: written instructions alone do not suffice. Magn Reson Med Sci 19(3):207–215

    Article  Google Scholar 

  23. Jeong TS et al (2017) Correlation between MRI grading system and surgical findings for lumbar foraminal stenosis. J Korean Neurosurg Soc 60(4):465–470

    Article  Google Scholar 

  24. Kang WY et al (2017) Is multidetector computed tomography comparable to magnetic resonance imaging for assessment of lumbar foraminal stenosis? Acta Radiol 58(2):197–203

    Article  Google Scholar 

  25. Wildermuth S et al (1998) Lumbar spine: quantitative and qualitative assessment of positional (upright flexion and extension) MR imaging and myelography. Radiology 207(2):391–398

    Article  CAS  Google Scholar 

  26. Siller S et al (2018) Painless motor radiculopathy of the cervical spine: clinical and radiological characteristics and long-term outcomes after operative decompression. J Neurosurg Spine 28(6):621–629

    Article  Google Scholar 

  27. Meacock J et al (2021) Systematic review of radiological cervical foraminal grading systems. Neuroradiology 63(3):305–316

    Article  Google Scholar 

  28. Ozaki M et al (2020) Quantitative evaluation for cervical foraminal bony stenosis based on angled sagittal slices along a nerve root on computed tomography. J Clin Neurosci 71:89–92

    Article  Google Scholar 

  29. Jones A et al (2005) The Modic classification: inter and intraobserver error in clinical practice. Spine 30(16):1867–1869

    Article  Google Scholar 

  30. Fayad F et al (2009) Reliability of a modified modic classification of bone marrow changes in lumbar spine MRI. Joint Bone Spine: Revue du Rhumatisme 76(3):286–289

    Article  Google Scholar 

  31. Andreisek G, Hodler J, Steurer J (2011) Uncertainties in the diagnosis of lumbar spinal stenosis. Radiology 261(3):681

    Article  Google Scholar 

  32. Stafira JS et al (2003) Qualitative assessment of cervical spinal stenosis: observer variability on CT and MR images. AJNR Am J Neuroradiol 24(4):766–769

    PubMed  PubMed Central  Google Scholar 

  33. He X et al (2018) Automated neural foraminal stenosis grading via task-aware structural representation learning. Neurocomputing 287:185–195

    Article  Google Scholar 

  34. Hong Y et al (2020) MMCL-Net: Spinal disease diagnosis in global mode using progressive multi-task joint learning. Neurocomputing 399:307–316

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    John Hutchins, Hanna Hebelka, Kerstin Lagerstrand & Helena Brisby

  2. Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden

    John Hutchins & Helena Brisby

  3. Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden

    Hanna Hebelka

  4. Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden

    Kerstin Lagerstrand

Authors
  1. John Hutchins
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hanna Hebelka
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kerstin Lagerstrand
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Helena Brisby
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to John Hutchins.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hutchins, J., Hebelka, H., Lagerstrand, K. et al. A systematic review of validated classification systems for cervical and lumbar spinal foraminal stenosis based on magnetic resonance imaging. Eur Spine J 31, 1358–1369 (2022). https://doi.org/10.1007/s00586-022-07147-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-022-07147-5

Keywords

Search

Navigation