Genant Vertebral Grade
Semiquantitative grading of vertebral compression fracture from anterior, middle and posterior heights.
The Genant semiquantitative method grades vertebral compression fractures by the fractional loss of vertebral body height, classifying wedge, biconcave and crush deformities into mild, moderate and severe grades.
📐 Formula
Height loss (%) vs tallest wall → grade 0 (<20%), 1 (20-25%), 2 (25-40%), 3 (>40%)
🎯 When to Use
- Assessing osteoporotic or pathological vertebral compression fractures on radiographs, CT or MRI.
- Standardised reporting and serial follow-up of vertebral height loss.
- Screening for prevalent and incident vertebral fractures.
⚙️ How It Works
- Measure anterior, middle and posterior vertebral body heights.
- Determine the maximal height loss relative to the tallest of the three walls (a proxy for the expected normal height).
- Grade 0 (normal): <20% height loss.
- Grade 1 (mild): 20-25% loss.
- Grade 2 (moderate): 25-40% loss.
- Grade 3 (severe): >40% loss.
📊 Interpreting the Result
- Higher grades correlate with greater fracture burden and future fracture risk.
- The deformity pattern (anterior wedge, biconcave, crush) is inferred from which wall is most reduced.
- Any grade ≥1 in the appropriate clinical context supports osteoporosis diagnosis.
⚠️ Limitations & Pitfalls
- Does not distinguish osteoporotic from malignant or traumatic aetiology.
- Non-fracture deformities (Scheuermann, remodelling, projectional artefact) can mimic mild grades.
- Comparison to an adjacent normal vertebra is preferred when available; the tallest-wall proxy is an approximation.
📚 References
- Genant HK, Wu CY, van Kuijk C, Nevitt MC. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res. 1993;8(9):1137-1148.
⚕️ For clinical decision support only. Always verify calculations and apply clinical judgment.