Pattern of intervertebral disc degeneration in the cervicothoracic junctional region

Abstract

There have been no reports describing the pattern of degenerative changes of spinal segments within the cervicothoracic (CT) transitional junction. To address this deficiency, intervertebral disc degenerative changes in this region were studied between the C6 to T4 vertebrae, using hemisected spinal columns from 96 individuals (69 male and 27 female). Sagittally sectioned spinal columns were inspected macroscopically by one observer and graded using previously reported grading scales. In addition, endplate irregularity, intervertebral disc degenerative changes, discal splitting and vertebral body marginal osteophytes were recorded. Combining all classifications of degeneration, the frequency of disc degeneration at C6–C7 was 49%, C7−T1 = 42%, T1−T2 = 40%, T2−T3 = 50% and T3−T4 = 44%. Significant age trends were noted, with 25% of all discs showing degeneration in the youngest group, compared to 58% in the oldest group. The incidence of disc degenerative changes through this transition declined from the C6–C7 to the T1–T2 segments but increased slightly for the more severe changes at the T2–T3 and T3–T4 segments. In one third of cases demonstrating degenerative discal changes no evidence of osteophyte formation was present. The manual therapist should not exclude the possibility of discal pathology in patients presenting with cervicothoracic pain, particularly if the patient is over 30 years of age.