Spine Grading: Pfirrmann / Modic / Meyerding — free guideline decision tool
Three core spine imaging grading systems in one tool: pick a system, then read out Pfirrmann (disc degeneration I–V), Modic (endplate changes I–III, auto-typed from T1/T2 signal) and Meyerding (lumbar spondylolisthesis I–V, auto-graded from percent slip). Instant, browser-side.
Open guideline tool →Guideline-based
Implements the decision logic from published clinical guidelines.
Runs in your browser
No installation. Enter the patient's values and get a guideline recommendation instantly.
Data stays local
Nothing is uploaded. Results are for licensed clinicians only.
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Grading system | Pfirrmann (disc degeneration) |
|---|---|
| Pfirrmann grade (signal / NP-annulus distinction / height) | I — homogeneous bright white, clear NP/annulus, normal height |
| Modic: T1 signal | Hypointense |
| Modic: T2 signal | Hypointense |
| Meyerding: percent anterior slip (%; leave blank to use A/B below) | 30 |
| Meyerding: slip distance A (mm, optional) | 6 |
| Meyerding: AP diameter of lower vertebra B (mm, optional) | 30 |
→Pfirrmann gradeGrade I
- Degeneration stage：Normal disc (I normal; II–III early; IV–V advancing/end-stage)
- Features：Homogeneous, bright white (well-hydrated), clear NP/annulus distinction, normal height.
- Reading tips：Sagittal T2. Grade I hinges on NP homogeneity; the III→IV step hinges on loss of the NP/annulus distinction.
| Grading system | Meyerding (spondylolisthesis) |
|---|---|
| Pfirrmann grade (signal / NP-annulus distinction / height) | V — inhomogeneous black, collapsed disc space |
| Modic: T1 signal | Hyperintense |
| Modic: T2 signal | Hyperintense |
| Meyerding: percent anterior slip (%; leave blank to use A/B below) | 30 |
| Meyerding: slip distance A (mm, optional) | 6 |
| Meyerding: AP diameter of lower vertebra B (mm, optional) | 30 |
→Meyerding gradeGrade II
- Anterior slip：30%
- Category：Low-grade (I–II, ≤50%)
- Cut-offs：I 0–25% | II 25–50% | III 50–75% | IV 75–100% | V >100%
Common questions
What is Spine Grading: Pfirrmann / Modic / Meyerding?
Three core spine imaging grading systems in one tool: pick a system, then read out Pfirrmann (disc degeneration I–V), Modic (endplate changes I–III, auto-typed from T1/T2 signal) and Meyerding (lumbar spondylolisthesis I–V, auto-graded from percent slip). Instant, browser-side.
How is Spine Grading: Pfirrmann / Modic / Meyerding calculated? What is the core formula?
Pfirrmann I–V (homogeneity / NP-annulus distinction / T2 signal / height). Modic: I = T1 hypo, T2 hyper (edema); II = T1 hyper, T2 hyper or iso (fat); III = T1 hypo, T2 hypo (sclerosis). Meyerding: I 0–25%, II 25–50%, III 50–75%, IV 75–100%, V >100% (spondyloptosis).
When is Spine Grading: Pfirrmann / Modic / Meyerding used?
Standardized grading for spine MRI/radiograph reports: disc degeneration, endplate marrow change type, and slip severity.
What are the key clinical points for Spine Grading: Pfirrmann / Modic / Meyerding?
Pfirrmann: I normal; II–III early; IV–V advancing/end-stage. Grade I hinges on NP homogeneity; III→IV on loss of NP/annulus distinction. Modic I (T1 hypo, T2 hyper) correlates relatively more with active pain and instability. Modic II (T1 hyper, T2 hyper/iso) is the most common and relatively stable; III (T1 hypo, T2 hypo) is subchondral sclerosis. Meyerding: 25% per grade, >100% = spondyloptosis; I–II low-grade, III–V high-grade (50% divide).
What are the limits and cautions when using Spine Grading: Pfirrmann / Modic / Meyerding?
For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
How is Spine Grading: Pfirrmann / Modic / Meyerding calculated in practice? Can you show a worked example?
Inputs: Grading system Pfirrmann (disc degeneration), Pfirrmann grade (signal / NP-annulus distinction / height) I — homogeneous bright white, clear NP/annulus, normal height, Modic: T1 signal Hypointense, Modic: T2 signal Hypointense, Meyerding: percent anterior slip (%; leave blank to use A/B below) 30, Meyerding: slip distance A (mm, optional) 6, Meyerding: AP diameter of lower vertebra B (mm, optional) 30 → Result: Pfirrmann grade Grade I（Degeneration stage: Normal disc (I normal; II–III early; IV–V advancing/end-stage), Features: Homogeneous, bright white (well-hydrated), clear NP/annulus distinction, normal height., Reading tips: Sagittal T2. Grade I hinges on NP homogeneity; the III→IV step hinges on loss of the NP/annulus distinction.） Inputs: Grading system Meyerding (spondylolisthesis), Pfirrmann grade (signal / NP-annulus distinction / height) V — inhomogeneous black, collapsed disc space, Modic: T1 signal Hyperintense, Modic: T2 signal Hyperintense, Meyerding: percent anterior slip (%; leave blank to use A/B below) 30, Meyerding: slip distance A (mm, optional) 6, Meyerding: AP diameter of lower vertebra B (mm, optional) 30 → Result: Meyerding grade Grade II（Anterior slip: 30%, Category: Low-grade (I–II, ≤50%), Cut-offs: I 0–25% | II 25–50% | III 50–75% | IV 75–100% | V >100%）
Run Spine Grading: Pfirrmann / Modic / Meyerding now
Three core spine imaging grading systems in one tool: pick a system, then read out Pfirrmann (disc degeneration I–V), Modic (endplate changes I–III, auto-typed from T1/T2 signal) and Meyerding (lumbar spondylolisthesis I–V, auto-graded from percent slip). Instant, browser-side.
Open guideline tool →For licensed clinicians. Not a substitute for clinical judgement.
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