Thamer⁦ Alghamdi

Feel BACKED into a corner reading spine MRIs? Looking for a better way to grade spinal stenosis? Time to get BACK to the basics! Want a grading system that’s both easy & reproducible? I’ve got your BACK! Here’s the lumbar stenosis grading system you’ve been waiting for! ➡️Think of it functionally. Nerves need to fit in their space, like you fit in clothing. 🔸Mild stenosis is like comfy clothes—no squeezing. 🔸Moderate stenosis clothing isn’t loose, but there isn’t extra room either. 🔸Severe stenosis is like too tight jeans, your body gets compressed ➡️How do we tell if the nerves have enough room—if the clothing fits loosely, tight, or too tightly? We look at the space around them. 🔸For the canal, it is CSF—if there is enough room, the extra space will be filled by CSF. 🔸For foramina, it is fat—extra room is filled by the foraminal fat. ➡️For the canal: 🔸Mild stenosis: Mild CSF attenuation, but still plenty of around, like plenty of room in comfy sweat pants 🔸Moderate stenosis: Less CSF & nerve roots appear aggregated. Like club clothes, not much room between skin & clothing 🔸Severe stenosis: It’s too tight jeans. Canal doesn’t just hug up to the nerve roots, it compresses them. ➡️For the foramina: 🔸Mild stenosis: Lose fat on 2 sides. Still comfy bc fat is preserved on the other 2 sides. 🔸Moderate stenosis: Lose fat on all 4 sides, but nerve is not compressed. Like a sleek outfit, it shows curves, but doesn’t deform them. 🔸Severe stenosis: Fat is gone & nerve is compressed. Like trying to fit into jeans from high school--squishing in everything you can to get it to fit. These systems both named the Lee systems. These are easy to remember, make sense, and are based in literature. *⃣Here are the references: 🔸Lee et al. AJR Am J Roentgenol. 2010 Apr;194(4):1095-8 🔸Park et al. Br J Radiol. 2013 May;86(1025):20120180 Hopefully, now when reading lumbar spine MRIs, these grading systems will get you BACK in the groove!