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Modic Classification

Modic classification concerns vertebral endplate degeneration and medullary modifications. All this degenerative modifications are paraphysiological (age-related) and can cause lower back pain.

This classification is based on MRI appearance of both vertebral endplate and subchondral bone marrow changes.

Note that mixed types 1/2 and 2/3 have been reported.

 

 
MODIC 1
MODIC 2
MODIC 3
T1
Hypointense Hyperintense Hypointense
T2
Hyperintense Isointense or slightly hyperintense Hypointense

Nurick Scale

Nurick scale is used to assess motor deficits due to cervical myelopathy.

 

Grade
Root Signs
Cord Involvement
Gait
Employment
0 Yes No  Normal Possible
1 Yes Yes Normal Possible
2 Yes Yes Mild abnormality Possible
3 Yes Yes Severe abnormality Impossible
4 Yes Yes Only with assistance Impossible

White-Panjab Scale

White-Panjab scale is used to assess vertebral instability in the lumbar spine.

Note that if score is >5 there is vertebral instability.

 

Variable
Points
Anterior elements destroyed or unable to function 2
Posterior elements destroyed or unable to function 2
Radiographic criteria 4
Flexion-Extension radiograph  
Sagittal plane translation >4.5mm or 15% 2
Sagittal plane rotation  
15° at L1-L2, L2-L3, L3-L4 2
20° at L4-L5 2
25° at L5-S1 2
Resting radiograph  
Sagittal plane displacement >4.5mm or 15% 2
Relative sagittal plane angulation >22° 2
Cauda equina damage 3
Dangerous loading anticipated 1

 

References

The Modic Vertebral Endplate and Marrow Changes: Pathologic Significance and Relation to Low Back Pain and Segmental Instability of the Lumbar Spine. R.Rahme et.al. AJNR 29, May 2008.

Cervical Spondylotic Myelopathy: Pathophysiology, Clinical Presentation, and Treatment. Darren R. Lebl MD et.al. HSSJ (2011) 7: 170–178

Clinical spinal instability and low back pain. Manohar M. Panjabi. Journal of Electromyography and Kinesiology 13 (2003) 371–379

 

Authors

 

Gabriele Costantito, MD

Neurosurgeon Consultant
University of Florence - (Siena)
ARNAS "Civico", Palermo
Scientific Team UpSurgeOn

 

Giorgio Saraceno, MS

Medical Student
University of Brescia 
Scientific Team UpSurgeOn

 


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