Radiological Classification for Degenerative Lumbar Spine Disease: A Literature Review of the Main Systems

Author(s): Marcelo Molina , Sebastián Vial

Study Design:

Systematic review

Objectives:

Performed a systematic review of available lumbar spinal degenerative disease classifications.

Methods:

We performed a systematic literature review search for papers that proposed or described radiological classification systems for degenerative lumbar spine disease, such as lumbar disc herniation, facet joint arthritis, spondylolisthesis, and lumbar stenosis. The literature was performed in MEDLINE and EMBASE, limited to English articles published from 1980 to the present. The reliability tests of the reviewed articles were assessed with the “Intraclass Correlation Coefficients” (ICC) and “Cohen's Kappa coefficient” (k).

Results:

We found 1873 articles. A total of 64 articles were reviewed, identifying 31 radiological classification systems. We found 7 classifications for degenerative disc disease, 7 for disc herniation, 7 for facet joint osteoarthritis, 8 for degenerative spinal stenosis, and 2 for degenerative spondylolisthesis. Of the 31 systems found, 24 had interrater agreement studies. The clinical orientation of the classification was analyzed when appropriate.

Discussion:

Reliability studies play a crucial role in evaluating a classification system as they enable reproducibility among evaluators, thereby fortifying the system. Classifications should not only be endorsed based on their validation and reliability studies, but it is also crucial to assess their feasibility for practical implementation in clinical settings.

Conclusions:

A classification system should have a reliability with Kappa or ICC over 0.60 to be recommended. It should provide a clinical orientation to make therapeutic decisions and form part of a guideline. Continued research on classification development is essential to improve systems, enhancing their clinical utility and bolstering their reliability.