12. Assessment of age-related intervertebral disc degenerations of the cervical spine in different age groups: a kinematic MRI study

Abstract

<h3>BACKGROUND CONTEXT</h3> Cervical intervertebral disc (IVD) degeneration is a common cause of neck and arm pain in adults and a frequent finding in imaging studies. <h3>PURPOSE</h3> This study aimed to assess the age-related degenerations of the cervical IVDs at each cervical spinal level in different age groups using the kinematic magnetic resonance imaging (KMRI). <h3>STUDY DESIGN/SETTING</h3> Cross-sectional study using KMRI. <h3>PATIENT SAMPLE</h3> This study included 1300 symptomatic patients who had undergone upright cervical spine KMRI from February 2019 to November 2021. <h3>OUTCOME MEASURES</h3> Pfirrmann classification of intervertebral disc degeneration. <h3>METHODS</h3> Patients were divided into five equal groups, each with 260 patients based on their ages. Group 1 included patients from 20 to 29 years, group 2 from 30 to 39 years, group 3 from 40 to 49 years, group 4 from 50 to 59 years, and group 5 were patients aged 60 years and above. On T2-weighted sagittal MRI, Pfirrmann grading system was used to grade the IVD degeneration into five grades. Considerable disc degeneration was reported with a Pfirrmann grade IV or V. A total of 7800 cervical IVDs from C2/3 to C7/T1 were evaluated. The severity and pattern of IVD degeneration in each age group was analyzed. <h3>RESULTS</h3> Overall, 4.4% of discs were grade I, 21.0% grade II, 55.1% grade III, 17.1% grade IV, and 2.5% grade V. The number of degenerated discs increased gradually with age groups; 4.9%, 8.4%, 16.4%, 24.6%, and 43.4% in groups 1, 2, 3, 4, and 5, respectively, P < 0.001. In group 1, the most common grade was grade II (41.5%), and the most common degenerated level was C2/3 (25%). In group 2, the most common grade was grade III (53.1%), and the most common degenerated level was C5/6 (29.0%). In group 3, the most common grade was grade III (60.2%), and the most common degenerated level was C5/6 (33.1%). In group 4, the most common grade was grade III (67.0%), and the most common degenerated level was C5/6 (31.3%). In group 5, the most common grade was grade III (56.0%), and the most common degenerated level was C5/6 (24.8%). In all groups, C7/T1 was the least common degenerated disc (6.6%, 3.1%, 3.5%, 4.7% and 8.7% in groups 1, 4 and 5, respectively). In groups 1 and 2, 92.1% and 86.3% of subjects, did not have considerable disc degeneration. In group 5, 19.5% of patients had 2-level disc degeneration, 15.5% had 3-level disc degeneration, and the incidence of 6-level degeneration was 11.2%. In patients with single-level disc degeneration, C5/6 was the most common degenerated level (45.3%). In patients with 2-level degeneration, C5/6 and C6/7 were the most common (49.7%). In patients with 3-level degeneration, C4/5, C5/6, and C6/7 were the most common (38.5%). In patients with 4-level degeneration, C2/3, C3/4, and C5/6 were the most common (36.2%). Skip-level degeneration was found in 18.2%, 30.2%, and 20.3% of patients with 2-level, 3-level, and 4-level degeneration, respectively. <h3>CONCLUSIONS</h3> This study evaluated the severity and pattern of IVD degeneration at each level of the cervical spine in different age groups. The number and severity of degenerated discs increases with age. Adjacent-level degeneration is more common than skip-lesion degeneration in patients with multilevel disc degeneration. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.