ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2016
The Pfirrmann classification of lumbar intervertebral disc degeneration: an independent inter- and intra-observer agreement assessment.
Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 96 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
96 citing papers in PubMed, 136 citations in OpenAlex.
- Biomechanical Comparisons of Two Types of Tuina in Treating Lumbar Disc Herniation: A Finite Element Analysis.Pain research & management · 2026Trial
- Transparent, Reproducible Text-Based Phenotyping of Lumbar Intervertebral Disc Degeneration from 500 Consecutive MRI Reports, with a Pre-Specified Image Analysis Framework.Diagnostics (Basel, Switzerland) · 2026Article
- Quantification of intervertebral disc degeneration using dual-energy computed tomography collagen maps: a comparative study with MRI Pfirrmann grading.Scientific reports · 2026Article
- HDAC1 maintains metabolic homeostasis in nucleus pulposus cells via post-translational modification interactions with YBX1.Experimental & molecular medicine · 2026Article
- MRI-based radiomics reveals disc-level radiomic heterogeneity and is associated with symptom severity in single-level lumbar disc herniation.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026Article
- Spinal mobility and paraspinal muscle degeneration: a cross-sectional analysis from the Berlin Back Study.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026Article
- Diagnostic Features of Discogenic Low Back Pain: A Narrative Review and Suggested Areas for Future Research and Clinical Practice.JOR spine · 2026Review
- Association between lumbar vertebral body bone quality and cranial/caudal endplate bone quality with intervertebral disc degeneration: a retrospective study of 2018 patients.Journal of orthopaedic surgery and research · 2026Article
- A Challenge-Oriented Review of Delivery Systems for Cell and Gene Therapies in Intervertebral Disc Degeneration.Bioengineering (Basel, Switzerland) · 2026Review
- Severe Disc degeneration is associated with lower caudal subendplate hounsfield unit values in degenerative lumbar spinal stenosis.BMC musculoskeletal disorders · 2026Article
- Bioinformatics analyses of a potential miRNA‒mRNA regulatory axis in lumbar degenerative disc disease.BMC medical genomics · 2026Article
- Machine learning-based identification and ranking of risk factors for lumbar paraspinal muscle atrophy.Archives of orthopaedic and trauma surgery · 2026Article
- Advances and challenges in AI-assisted MRI for lumbar disc degeneration detection and classification.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026Review
- SpineScan: a deep learning model for lumbar spine MRI annotation and Pfirrmann grading assessment.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026Article
- A fast classification system for adult spinal deformity with sagittal imbalance based on spinal sagittal parameters.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026Article
- Effect of Oxidative Stress Intensity on Inflammatory, Bone Turnover, and Haemostasis Biomarkers in Patients with Spinal Osteoarthritis.Life (Basel, Switzerland) · 2026Article
- Automated radiomics pipeline integrating TotalSpineSeg for Pfirrmann grading of lumbar disc degeneration with SHAP-based interpretability.Frontiers in medicine · 2026Article
- Article
- Review
- Progression of lumbar disc degeneration: A 14-year follow-up study examining Pfirrmann grading and its individual disc components.Acta radiologica open · 2025Article
36 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeGrading inter-vertebral disc degeneration (IDD) is important in the evaluation of many degenerative conditions, including patients with low back pain. Magnetic resonance imaging (MRI) is considered the best imaging instrument to evaluate IDD. The Pfirrmann classification is commonly used to grade IDD; the authors describing this classification showed an adequate agreement using it; however, there has been a paucity of independent agreement studies using this grading system. The aim of this study was to perform an independent inter- and intra-observer agreement study using the Pfirrmann classification.
methodsT2-weighted sagittal images of 79 patients consecutively studied with lumbar spine MRI were classified using the Pfirrmann grading system by six evaluators (three spine surgeons and three radiologists). After a 6-week interval, the 79 cases were presented to the same evaluators in a random sequence for repeat evaluation. The intra-class correlation coefficient (ICC) and the weighted kappa (wκ) were used to determine the inter- and intra-observer agreement.
resultsThe inter-observer agreement was excellent, with an ICC = 0.94 (0.93-0.95) and wκ = 0.83 (0.74-0.91). There were no differences between spine surgeons and radiologists. Likewise, there were no differences in agreement evaluating the different lumbar discs. Most differences among observers were only of one grade. Intra-observer agreement was also excellent with ICC = 0.86 (0.83-0.89) and wκ = 0.89 (0.85-0.93).
conclusionsIn this independent study, the Pfirrmann classification demonstrated an adequate agreement among different observers and by the same observer on separate occasions. Furthermore, it allows communication between radiologists and spine surgeons.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.