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Modic Classification

Modic classification concerns vertebral endplate degeneration and medullary modifications. All this degenerative modifications are paraphysiological (age-related) and can cause lower back pain.

This classification is based on MRI appearance of both vertebral endplate and subchondral bone marrow changes.

Note that mixed types 1/2 and 2/3 have been reported.


Hypointense Hyperintense Hypointense
Hyperintense Isointense or slightly hyperintense Hypointense

Nurick Scale

Nurick scale is used to assess motor deficits due to cervical myelopathy.


Root Signs
Cord Involvement
0 Yes No  Normal Possible
1 Yes Yes Normal Possible
2 Yes Yes Mild abnormality Possible
3 Yes Yes Severe abnormality Impossible
4 Yes Yes Only with assistance Impossible

White-Panjab Scale

White-Panjab scale is used to assess vertebral instability in the lumbar spine.

Note that if score is >5 there is vertebral instability.


Anterior elements destroyed or unable to function 2
Posterior elements destroyed or unable to function 2
Radiographic criteria 4
Flexion-Extension radiograph  
Sagittal plane translation >4.5mm or 15% 2
Sagittal plane rotation  
15° at L1-L2, L2-L3, L3-L4 2
20° at L4-L5 2
25° at L5-S1 2
Resting radiograph  
Sagittal plane displacement >4.5mm or 15% 2
Relative sagittal plane angulation >22° 2
Cauda equina damage 3
Dangerous loading anticipated 1



The Modic Vertebral Endplate and Marrow Changes: Pathologic Significance and Relation to Low Back Pain and Segmental Instability of the Lumbar Spine. R.Rahme AJNR 29, May 2008.

Cervical Spondylotic Myelopathy: Pathophysiology, Clinical Presentation, and Treatment. Darren R. Lebl MD HSSJ (2011) 7: 170–178

Clinical spinal instability and low back pain. Manohar M. Panjabi. Journal of Electromyography and Kinesiology 13 (2003) 371–379




Gabriele Costantito, MD

Neurosurgeon Consultant
University of Florence - (Siena)
ARNAS "Civico", Palermo
Scientific Team UpSurgeOn


Giorgio Saraceno, MS

Medical Student
University of Brescia 
Scientific Team UpSurgeOn