Prevalence and pattern of lumbar magnetic resonance imaging changes in a population study of one thousand fortythree individuals. The diagnosis of spinal stenosis relies primarily on imaging to provide objective evidence of neurovascular compromise. Nomenclature and classification of lumbar disc pathology recommendations of the combined task forces of the north american spine society, american society of spine radiology, and american society of neuroradiology david f. Differing characteristics of normal disc, spondylosis deformans and intervertebral osteochondrosisdisc degeneration.
Request pdf on feb 1, 2003, pekka jartti and others published radiological classification and nomenclature of lumbar intervertebral disc disorders find, read and cite all the research you. The above illustrations follow the recommendations described in the 2014 v2. Objective to provide a resource that promotes a clear understanding of lumbar disc terminology among clinicians, radiologists, and researchers. In march 2001, a joint task force led by the north american spine society consisting of the american society of spine radiology and the american society of neuroradiology published a paper in spine titled nomenclature and classification of lumbar disc pathology. Wiesel, published his teams findings in the september 1984 edition of the medical journal spine the incidence of positive cat scans in an asymptomatic group of patients. Nov 01, 2014 the above document by fardon et al, listed in this issues table of contents with links to the full versions recently published by spine and the spine journal, represents an update to the original article coauthored by david fardon, md, and pierre milette, md, entitled nomenclature and classification of lumbar disk pathology. How should we grade lumbar disc herniation and nerve root. A practical guide to the application of ajnr guidelines. Nomenclature and classification of lumbar disc pathology. Broad 2550% of circumference focal jul 01, 2015 the nomenclature and classification of lumbar disc pathology consensus, published in 2001 by the collaborative efforts of the north american spine society, the american society of spine radiology and the american society of neuroradiology, has guided radiologists, clinicians and the public for more than a decade. Their recommendations for lumbar disc nomenclature were released in 2001 and revised in 2014.
Asnr nomenclature and classification of lumbar disc pathology figure 1. It is important to use consistent and agreed upon nomenclature when describing the various morphologies of disc herniation to avoid causing confusion with referring providers the above illustrations follow the recommendations described in the 2014 v2. Consequently, there is an urgent need to clarify the occurrence and distribution features of ldd and. Differing characteristics of normal disc, spondylosis deformans and intervertebral osteochondrosis disc degeneration. Recommendations of the combined task forces of the american. The recently released lumbar disc nomenclature version 2. In order to study the type and number of cat scan abnormalities of the lumbar spine that occur in. Another limitation is the relatively few patients with disc extrusions, which may reduce the statistical power. Fardon df, williams al, dohring ej, murtagh fr, gabriel rothman sl, sze gk. The nomenclature and classification of lumbar disc pathology consensus, published in 2001, by the collaborative efforts of the north american spine society nass, the american society of spine radiology assr and the american society of neuroradiology asnr, has guided radiologists, clinicians, and interested public for over a decade. A practical guide to the application of ajnr guidelines for.
Recommendations of the combined task forces of the north american spine society, american society of spine radiology, and american society of neuroradiology. A synopsis of nomenclature and classification of lumbar. Sze t heabovedocumentbyfardonetal,listedinthisissuestable. The lumbar spine is made up of 5 load transferring bones called vertebrae. Mri findings of disc degeneration are more prevalent in. A new option for the treatment of lumbar disc disease is lumbar disc replacement. Jul 01, 2015 further investigation is needed to compare the containment of disc material between mdct and mri findings. It is important to use consistent and agreed upon nomenclature when describing the various morphologies of disc herniation to avoid causing confusion with referring providers. The nomenclature and classification of lumbar disc pathol. Multiple factors often present in degenerative disc disease including flaval hypertrophy, facet joint disease, osteophytes, disc bulges and herniations. Diam spinal stabilization system p140007 fda introduction. Such paradiscal rami are likely to be another source of innervation to the discs.
Magnetic resonance classification of lumbar intervertebral. This technique involves removing all of the intervertebral disc as in a spinal fusion, but instead of replacing the disc with bone, an artificial disc is inserted. Discogenic marrow edema modic type 1 signal changes, when moderate. Abstract lumbar intervertebral disc herniations are the most common causes for workingage individuals to undergo lumbar spine surgery. Jan 01, 2007 in march 2001, a joint task force led by the north american spine society consisting of the american society of spine radiology and the american society of neuroradiology published a paper in spine titled nomenclature and classification of lumbar disc pathology. The lumbar spine comprises the 5 vertebrae that are below the thoracic vertebrae and are labeled l1, l2. Even in the lumbar area, there are significant anatomic differences between upper and lower vertebrae and certain concepts, like the lateral recess syndrome, are really meaningful only in relation to the l4, l5, and s1 vertebrae. Nomenclature and classification of lumbar disc pathology asnr herniation. Recommendations of correct nomenclature and classification of lumbar disc pathology in magnetic resonance imaging were published in 2001 by combined task force of the american society of spine radiology, the american society of neuroradiology, and the north american spine society and subsequently endorsed by american. Finally, we used the nomenclature of nass for the evaluation of cervical discs, but this was designed for lumbar disc pathology. Some rami communicantes cross intervertebral discs and are embedded in the connective tissue of the disc deep to the origin of psoas. The north american spine society nass initiated efforts to develop detailed definitions of lumbar disc pathology terms and has provided sustained support of the project.
Fardon, md, chairperson, clinical task force pierre c. All scans were analyzed independently by three observers. This paper was instrumental in developing terminology and definitions that all. The reliability of the algorithm in depicting intervertebral disc alterations was tested on the magnetic resonance images of 300 lumbar intervertebral discs in 60 patients 33 men and 27 women with a mean age of 40 years range, 1083 years. Top left axial, top right sagittal, and bottom coronal images demonstrate that the normal disc, composed of central np and peripheral af, is wholly within the boundaries of the disc space, as defined, craniad and caudad by the vertebral body end plates and peripherally by the planes of the outer edges of the vertebral apophyses, exclusive of osteophytes. Review and update of correct nomenclature for lumbar. Sep 25, 2018 fardon df, williams al, dohring ej, murtagh fr, gabriel rothman sl, sze gk. The above document by fardon et al, listed in this issues table of contents with links to the full versions recently published by spine and the spine journal, represents an update to the original article coauthored by david fardon, md, and pierre milette, md, entitled nomenclature and classification of lumbar disk pathology. This leak presses on the local nerve root causing the pain.
Independent efforts by neuroradiologists led the american society of spine radiology assr and american society of neuroradiology asnr to organize a task force of. The most commonly used and studied classification system for lumbar nerve root compression includes proposed nomenclature by pfirrmann grading system and van rijn. Recommendations of the combined task forces of the north american spine society, american society of. A synopsis of nomenclature and classification of lumbar disc. Tears in the disc wall usually occur due to aging andor trauma 3,7. Radiological classification and nomenclature of lumbar. Recommendations of the combined task forces of the north american spine society, the american. The proper terminology for reporting lumbar intervertebral disk. Milette, md, chairperson, imaging task force clinical task force members. A practical guide to the application of ajnr guidelines for nomenclature and classification of lumbar disc pathology in magnetic resonance imaging mri.
American journal of neuroradiology skip to main page content home about ajnr author info editorial board submit online most cited most read help search for keyword. The paper nomenclature and classification of lumbar disc pathology, recommendations of the combined task forces of the american society of spine. They are stacked in a column with an intervertebral disc sandwiched between each set of vertebrae. Recommendations of the combined task forces of the north american spine society, the american society of spine radiology and the. Discogenic marrow edema modic type 1 signal changes, when moderate or marked, may indicate symptomatic disc degeneration. The imaging features may be roughly classified into two categories. After pooling the interobserver agreement of various nomenclature systems, there is level 1 and 2 evidence to suggest that the ctf classification of lumbar disc disease has significant interobserver agreement and van rijn et al. Lumbar disc disease has a disabling impact on global people with heavy burden on society, mainly consisting of lumbar disc degeneration ldd and lumbar disc herniation ldh. Spine volume 26, number 5, pp e93e1 2001, lippincott. Cases from these cohort were utilized for this educational exhibit. Intervertebral disc disease nomenclature has changed over the years, and a familiarity with current definitions is essential if clear communication is to be achieved via radiology reports or referrals, especially as lumbar disc disease is a common problem and a source of a great deal of imaging. Recommendations of the combined task forces of the north american spine society, the american society of spine radiology and the american society of neuroradiology.
Recommendations of the combined task forces of the north american spine society, the american society of spine radiology. The above document by fardon et al, listed in this issues table of contents with links to the full versions recently published by spine and the spine journal, represents an update to the original article coauthored by david fardon, md, and pierre milette, md, entitled nomenclature and classification of lumbar. Lumbar degenerative disk disease clinical presentation. To provide a resource that promotes a clear understanding of lumbar disc terminology among clinicians, radiologists, and r. Intervertebral disc disease nomenclature radiology. Patients with a family history of disc disease or are in physically demanding jobs, or who have certain medical comorbidities such as obesity, are at an increased risk of developing a lumbar disc herniation.
Objective to provide a resource that promotes a clear understanding of lumbar disc terminology among. Pdf the epidemiology and pathophysiology of lumbar disc. The advantage of this technique is the person is able to retain close to normal motion at the level. It was authored by david fardon, md, and pierre milette, md. Classification, diagnostic imaging, and imaging characterization of a lumbar herniated disc. Mri is a mainstay in the assessment of low back pain and degenerative disease of the lumbar spine. The paper nomenclature and classification of lumbar disc pathology, recommendations of the combined task forces of the american society of spine radiology, the american society of neuroradiology. Computeraided diagnosis of lumbar disc pathology from. The disc is within the boundaries of the disc space.
In this work, the term herniated nucleus pulposus con sidered synonymous with intervertebral disk. A clear understanding of lumbar disc and nerve root compression terminology is critical to a multidisciplinary approach for making diagnostic and therapeutic decisions in lumbar disc disease. Recommendations of the combined task forces of the north american spine society, the. A normal disc is composed of a central nucleus pulposus and peripheral annulus fibrosus. The nomenclature and classification of lumbar disc pathology consensus, published in 2001 by the collaborative efforts of the north american spine society nass, the american society of spine radiology assr, and the american society of neuroradiology asnr, has guided radiologists, clinicians, and interested public for more than a decade. Recommendations of the combined task forces of the north american spine society, the american society of spine radiology and the american society of. In total 5, 860 lumbar spines were performed with reports and images available in 5, 223 cases. In one of the modern eras first studies of its kind, george washington university medical center orthopedist, dr. Terms such as bulge, protrusion, extrusion, sequestration and migration all have specific meanings. We would like to show you a description here but the site wont allow us. Standardizing nomenclature is critical for promoting effective communication among radiologists and orthopaedic and neurological spine surgeons. The anterior longitudinal ligament is innervated by recurrent branches of rami communicantes 7.
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