COSMIN database

Review of existing grading systems for cervical or lumbar disc and facet joint degeneration

Kettler, A. and Wilke, H. J.
The aim of this literature review was to present and to evaluate all grading systems for cervical and lumbar disc and facet joint degeneration, which are accessible from the MEDLINE database. A MEDLINE search was conducted to select all articles presenting own grading systems for cervical or lumbar disc or facet joint degeneration. To give an overview, these grading systems were listed systematically depending on the spinal region they refer to and the methodology used for grading. All systems were checked for reliability tests and those recommended for use having an interobserver Kappa or Intraclass Correlation Coefficient >0.60 if disc degeneration was graded and >0.40 if facet joint degeneration was graded. MEDLINE search revealed 42 different grading systems. Thirty of these were used to grade lumbar spine degeneration, ten were used to grade cervical spine degeneration and two were used to grade both. Thus, the grading systems for the lumbar spine represented the vast majority of all 42 grading systems. Interobserver reliability tests were found for 12 grading systems. Based on their Kappa or Intraclass Correlation Coefficients nine of these could be recommended for use and three could not. All other systems could neither be recommended nor not be recommended since reliability tests were missing. These systems should therefore first be tested before use. The design of the grading systems varied considerably. Five grading systems were beginning with the lowest degree of degeneration, 37, however, with the normal, not degenerated state. A 5-grade scale was used in six systems, a 4-grade scale in 24, a 3-grade scale in eight and a 2-grade scale in three systems. In 15 cases the normal, not degenerated state was assigned to "grade 0", in another 15 cases, however, this state was assigned to "grade 1". This wide variety in the design of the grading systems makes comparisons difficult and may easily lead to confusion. We would therefore recommend to define certain standards. Our suggestion would be to use a scale of three to five grades, to begin the scale with the not degenerated state and to assign this state to "grade 0".
Eur Spine J
0940-6719 (Print)
Publication year:
Biological and physiological variables:
Biological and physiological variables
Adults (18-65)
Seniors (65+)
Diseases of and symptoms related to the musculoskeletal system and connective tissue
PRO / non-PRO:
Non-patient Reported Outcome
Type of measurement instrument:
6 - Clinical rating scales
8 - Imaging tests
Computed Tomography-Butler et al. (1990)
Computed tomography-Coste et al. (1994)
Computed tomography-Pathria et al. (1987)
Computed tomography-Weishaupt et al. (1999)
Conventional tomography-Demaerel et al. (1992)
Discography-Adams et al. 1986
Discography-Gunzburg et al. 1992
Discography-Schellhas et al. (1996)
Discography-Schneiderman et al. 1987
Discography-Viikari–Juntura et al. (1989)
Histology-Berlemann et al. 1998 and Gries et al. 2000
Histology-Boos et al. 2002
Histology- Gries et al. (2000)
Histology-Gunzburg et al, 1992
Macroscopic anatomy-Adams et al. 1996
Macroscopic anatomy-Galante 1967
Macroscopic anatomy-Nachemson 1960
Macroscopic anatomy-Silberstein (1965)
Macroscopic anatomy-Tanno et al. (2003)
Macroscopic anatomy-Thompson 1990
Macroscopic anatomy-Viikari–Juntura et al. (1989)
Macroscopic anatomy-Ziv et al 1993
Magnetic resonance imaging-Butler et al. 1990
Magnetic resonance Imaging- Grogan et al. (1997)
Magnetic resonance imaging-Gunzburg et al. 1992
Magnetic resonance imaging-Lehto et al. (1994)
Magnetic resonance imaging-Pfirrmann et al. 2001
Magnetic resonance imaging-Schneiderman et al. 1987
Magnetic resonance imaging-Tertti et al. 1991
Magnetic resonance imaging-Viikari–Juntura et al. (1989)
Magnetic resonance imaging- Weishaupt et al. (1999)
Plain radiography-Brooker and Barter (1965)
Plain radiography-Gordon 1991
Plain radiography-Kellgren and Lawrence 1952
Plain radiography-Kellgren et al. 1963
Plain radiography-Lane et al. 1993
Plain radiography-Madan et al. 2003
Plain radiography-Mimura 1994
Plain radiography-Pathria et al. (1987)
Plain radiography-Silberstein (1965)