Abstract

BackgroundThe progression of intervertebral disc (IVD) degeneration leads to rupture within IVD tissues. The location and appearance of areas of gaseous radiolucency in the IVD, known as vacuum phenomena (VPs), are considered to indirectly indicate the position and extent of IVD rupture. The clinical significance of VPs in degenerated IVDs is not fully understood. The purpose of this study is to assess and classify the morphology of IVD ruptures by the presence of intradiscal VPs, and to examine the association between morphological VP-positive IVD ruptures and degenerative lumbar diseases.MethodsIVD rupture was evaluated by the presence of VPs using computed tomography (CT) imaging. VP shape (spot, linear, island) was classified using sagittal imaging, and VP distribution (A-N: anterior AF-NP; N: NP only; N-P: NP-posterior AF; A-N-P: anterior and posterior AF-NP) was classified using axial imaging. The disc height index (DHI) was calculated from lateral radiographs. Disc degeneration and lumbar spinal stenosis were evaluated by MRI grade.ResultsIn the VP shape analysis, the island type was the most common, followed by linear and spot types. In the VP distribution analysis, A-N was the most common group, followed by N, N-P and A-N-P. Intra- and inter-observer reliabilities were statistically sufficient to classify different rupture shapes and distributions. The DHI tended to be lower in discs that contained VPs, especially in the anterior AF area. The shape and distribution of intradiscal VPs were significantly associated with the degree of disc degeneration and lumbar spinal stenosis graded by MRI. Discs with VPs extending from the NP into the anterior and/or posterior AF had a significantly higher proportion of advanced disc degeneration (Pfirrmann’s classification: grades IV and V).ConclusionsThis is the first study to analyze the morphology of IVD rupture evaluated by the presence of intradiscal VPs using CT imaging. This classification can comprehensively present the shape and axial distribution of VPs within IVDs. Intradiscal VPs are associated with the progression of disc degeneration and lumbar spinal stenosis.

Highlights

  • The progression of intervertebral disc (IVD) degeneration leads to rupture within IVD tissues

  • Except for the N distribution, all the discs with the vacuum phenomenon (VP) that extend from nucleus pulposus (NP) into anterior and/or posterior annulus fibrosus (AF) (A-N, N-P, A-N-P) had a significantly higher proportion of magnetic resonance imaging (MRI) grade V discs. These results suggested that intradiscal VPs extending from the N into AF area are associated with significant structural changes of IVDs

  • The results of this study revealed that intradiscal VPs, especially those extending from the N into the AF region, were associated with structural destruction of IVD tissues, including disc height narrowing

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Summary

Introduction

The progression of intervertebral disc (IVD) degeneration leads to rupture within IVD tissues. The location and appearance of areas of gaseous radiolucency in the IVD, known as vacuum phenomena (VPs), are considered to indirectly indicate the position and extent of IVD rupture. The purpose of this study is to assess and classify the morphology of IVD ruptures by the presence of intradiscal VPs, and to examine the association between morphological VP-positive IVD ruptures and degenerative lumbar diseases. The progression of IVD degeneration is known to lead to ruptures (including tears and/or cleft formation) within IVD tissues [1, 2]. The location and appearance of gas is considered to indirectly indicate the position and extent of rupture within the IVD. Magnetic resonance imaging (MRI) plays an important role in evaluating IVD pathologies [7], including tissue degeneration, it is less accurate than computed tomography (CT) for detecting VPs [8]

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