Prevalence Of Intervertebral Disc Degeneration Research Articles

Disc Degeneration and Cervical Spine Intervertebral Motion: A Cross-Sectional Study in Patients with Neck Pain and Matched Healthy Controls.

While neck pain can be defined in clinical terms, in most cases the underlying pathophysiology is largely unknown. Regional cervical spine range of motion is often found to be reduced in patients with neck pain compared to persons without pain although it is not clear if the decreased range is cause or effect. Less is known about the role of intervertebral kinematics and how that might be related to the presence of disc degeneration. In this study, the prevalence of intervertebral disc degeneration and continuous cervical intervertebral motion were both measured utilizing quantitative fluoroscopy (QF) in patients with subacute or chronic neck pain (n = 29) and gender-matched healthy controls (n = 30). A composite disc degeneration (CDD) score was calculated for each participant from the first, neutral, lateral fluoroscopic image. Intervertebral motion sharing parameters of motion-sharing inequality (MSI) and motion-sharing variability (MSV) were derived from the active cervical motion sequences obtained while patients were seated. The objective was to determine if average age, CDD, MSI, and MSV values were correlated and if there were differences in these variables between the neck pain group and the healthy control group. Correlation analysis was conducted for age, CDD, MSI, and MSV in each group. Age was moderately correlated with MSV in cervical spine extension in patients only (r = 0.63, p < 0.001). There were no significant differences in the prevalence of disc degeneration (CDD) between patients, who had on average mild pain and related disability, and healthy controls (median CDD 2 both groups, p = 0.94). There were also no significant differences in either flexion or extension intervertebral motion-sharing inequality or variability (MSI or MSV) between groups as measured during active cervical motion.

Quality of Life, Disability Level, and Pain Intensity among Patients after Lumbar Disc Surgery: An Observational Three-Month Follow-Up Study.

The prevalence of intervertebral disc degeneration in the lumbar region resulting in low back pain is high. One of the treatment options is neurosurgery. Previous studies and systematic reviews demonstrate the need to identify factors that affect the health-related quality of life of patients undergoing surgery. This study aimed to analyze the sociodemographic and clinical factors that affect the quality of life of patients undergoing lumbar disc surgery. A group of 128 patients was assessed for eligibility and qualified by radiological examinations for lumbar disc surgery by a neurosurgeon in the outpatient clinic. Finally, 110 patients were studied and evaluated 24 h and 3 months after surgery. Health-related quality of life (36-Item Short Form Survey, SF-36), disability level (Oswestry Disability Index, ODI), and pain intensity (Visual Analogue Scale, VAS) were assessed. The mean pain intensity before surgery was 7.8 ± 2.3 pts and decreased significantly 24 h after surgery, with a mean score of 3.8 ± 2.4 pts (p = 0.0000). After three months, the increase in pain intensity was at 4.8 ± 2.4 pts, but the score was still significantly better than before surgery (p = 0.0024). The mean ODI score before surgery was 29.3 ± 8.4 pts (slight disability), and three months after surgery, there was an insignificant increase to a mean value of 31.5 ± 10.4 pts (p = 0.0834). There was a statistically significant increase in quality-of-life scores at three months after surgery in the following domains: physical functioning (8.7%; p = 0.0176), bodily pain (26.2%; p = 0.0000), vitality (5.8%; p = 0.0132) and mental health (6.2%; p = 0.0163), and a decrease in role limitations due to physical problems (3.8; p = 0.0013) and general health perception (6.7%; p = 0.0112). In conclusion, the surgical procedure plays an important role in improving the quality of life of patients operated on for intervertebral disc degeneration. It was effective in reducing the pain level, especially 24 h after surgery; however, surgery did not affect the disability level.

Associations of myosteatosis with disc degeneration: A 3T magnetic resonance imaging study in individuals with impaired glycaemia.

Intervertebral disc degeneration (IVDD) may be linked to dysregulations of skeletal muscle glucose metabolism and fatty alterations of muscle composition (Myosteatosis). Our aim was to evaluate the different associations of magnetic resonance imaging (MRI)-based paravertebral myosteatosis with lumbar disc degeneration in individuals with impaired glucose metabolism and normoglycaemic controls. In total, 304 individuals (mean age: 56.3±9.1years, 53.6% male sex, mean body mass index [BMI]: 27.6±4.7kg/m2 ) from a population-based cohort study who underwent 3-Tesla whole-body chemical-shift-encoded (six echo times) and T2-weighted single-shot-fast-spin-echo MRI were included. Lumbar disc degeneration was assessed at motion segments L1 to L5, categorized according to the Pfirrmann score and defined as Pfirrmann grade>2 and/or disc bulging/herniation on at least one segment. Fat content of the autochthonous back muscles and the quadratus lumborum muscle was quantified as proton density fat fraction (PDFFmuscle ). Logistic regression models adjusted for age, sex, BMI and regular physical activity were calculated to evaluate the association between PDFFmuscle and outcome IVDD. The overall prevalence of IVDD was 79.6%. There was no significant difference in the prevalence or severity distribution of IVDD between participants with or without impaired glucose metabolism (77.7% vs. 80.7%, P=0.63 and P=0.71, respectively). PDFFmuscle was significantly and positively associated with an increased risk for the presence of IVDD in participants with impaired glycaemia when adjusted for age, sex and BMI (PDFFautochthonous back muscles : odds ratio [OR] 2.16, 95% confidence interval [CI] [1.09, 4.3], P=0.03; PDFFquadratus lumborum : OR 2.01, 95% CI [1.04, 3.85], P=0.04). After further adjustment for regular physical activity, the results attenuated, albeit approaching statistical significance (PDFFautochthonous back muscles : OR 1.97, 95% CI [0.97, 3.99], P=0.06; PDFFquadratus lumborum : OR 1.86, 95% CI [0.92, 3.76], P=0.09). No significant associations were shown in healthy controls (PDFFautochthonous back muscles : OR 0.62, 95% CI [0.34, 1.14], P=0.13; PDFFquadratus lumborum : OR 1.06, 95% CI [0.6, 1.89], P=0.83). Paravertebral myosteatosis is positively associated with intervertebral disc disease in individuals with impaired glucose metabolism, independent of age, sex and BMI. Regular physical activity may confound these associations. Longitudinal studies will help to better understand the pathophysiological role of skeletal muscle in those with concomitant disturbed glucose haemostasis and intervertebral disc disease, as well as possible underlying causal relationships.

Association of lumbar vertebral bone marrow and paraspinal muscle fat composition with intervertebral disc degeneration: 3T quantitative MRI findings from the population-based KORA study

ObjectiveTo assess the association of lumbar bone marrow adipose tissue fat fraction (BMAT-FF) and paraspinal muscle proton density fat fraction (PDFF) and their interplay with intervertebral disc degeneration (IVDD).MethodsIn this retrospective cross-sectional study based on a prospective population-based cohort, BMAT-FF and PDFF of asymptomatic individuals were calculated based on 3T-MRI dual-echo and multi-echo Dixon VIBE sequences. IVDD was assessed at motion segments L1 to L5 and dichotomized based on Pfirrmann grade ≥ 4 and/or presence of other severe degenerative changes or spinal abnormalities at least at one segment. Pearson’s correlation coefficients were calculated for BMAT-FF and PDFF. Univariable and multivariable logistic regression models for IVDD were calculated.ResultsAmong 335 participants (mean age: 56.2 ± 9.0 years, 43.3% female), the average BMI was 27.7 ± 4.5 kg/m2 and the prevalence of IVDD was high (69.9%). BMAT-FF and PDFF were significantly correlated (r = 0.31–0.34; p < 0.001). The risk for IVDD increased with higher PDFF (OR = 1.45; CI 1.03, 2.04) and BMAT-FF (OR = 1.56; CI 1.16, 2.11). Pairwise combinations of PDFF and BMAT-FF quartiles revealed a lower risk for IVDD in individuals in the lowest BMAT-FF and PDFF quartile (OR = 0.21; CI 0.1, 0.48). Individuals in the highest BMAT-FF and PDFF quartile showed an increased risk for IVDD (OR = 5.12; CI 1.17, 22.34)ConclusionLumbar BMAT-FF and paraspinal muscle PDFF are correlated and represent both independent and additive risk factors for IVDD. Quantitative MRI measurements of paraspinal myosteatosis and vertebral bone marrow fatty infiltration may serve as imaging biomarkers to assess the individual risk for IVDD.Key Points• Fat composition of the lumbar vertebral bone marrow is positively correlated with paraspinal skeletal muscle fat.• Higher fat-fractions of lumbar vertebral bone marrow and paraspinal muscle are both independent as well as additive risk factors for intervertebral disc degeneration.• Quantitative magnetic resonance imaging measurements of bone marrow and paraspinal muscle may serve as imaging biomarkers for intervertebral disc degeneration.

The effect of transitional vertebrae and spina bifida occulta on disc herniation, disc degeneration, and end-plate changes in pediatric patients with low back pain.

The aim of the study is to investigate the assumption whether lumbosacral transitional vertebrae (LSTV) and spina bifida occulta (SBO) cause lumbar disc herniation (LDH), intervertebral disc degeneration (IDD), and vertebral endplate changes / Modic changes (MCs) in children and adolescents with low back pain (LBP). Four hundred patients (aged 10-17) with LBP persisting for at least six weeks were included in the study. Lumbosacral X-rays were examined for the presence of LSTV and SBO. The prevalence of IDD/MCs and LDH at L4-5 and L5-S1 levels were investigated by evaluating the lumbosacral MRI of the patients with and without LSTV-SBO. The study population consisted of 219 girls and 181 boys with mean age 14.9±1.9. LSTV was determined in 67 (16.8%) patients and SBO in 62 (15.5%). No significant difference was observed in the prevalence of IDD, MCs, and LDH in patients with and without LSTV/SBO. LSTV and SBO were not observed in approximately 80% of patients without LDH and IDD/MCs. The presence of LSTV and SBO does not appear to represent a risk factor for early degeneration in lumbar spine and LDH in children and adolescents with LBP.

MRI evaluation of spontaneous intervertebral disc degeneration in the alpaca cervical spine.

Animal models have historically provided an appropriate benchmark for understanding human pathology, treatment, and healing, but few animals are known to naturally develop intervertebral disc degeneration. The study of degenerative disc disease and its treatment would greatly benefit from a more comprehensive, and comparable animal model. Alpacas have recently been presented as a potential large animal model of intervertebral disc degeneration due to similarities in spinal posture, disc size, biomechanical flexibility, and natural disc pathology. This research further investigated alpacas by determining the prevalence of intervertebral disc degeneration among an aging alpaca population. Twenty healthy female alpacas comprised two age subgroups (5 young: 2-6 years; and 15 older: 10+ years) and were rated according to the Pfirrmann-grade for degeneration of the cervical intervertebral discs. Incidence rates of degeneration showed strong correlations with age and spinal level: younger alpacas were nearly immune to developing disc degeneration, and in older animals, disc degeneration had an increased incidence rate and severity at lower cervical levels. Advanced disc degeneration was present in at least one of the cervical intervertebral discs of 47% of the older alpacas, and it was most common at the two lowest cervical intervertebral discs. The prevalence of intervertebral disc degeneration encourages further investigation and application of the lower cervical spine of alpacas and similar camelids as a large animal model of intervertebral disc degeneration.

The associations between disc degeneration and co-existent structural abnormalities in the lumbosacral spine – A 3.0T MRI study of community-based adults

s / Osteoarthritis and Cartilage 23 (2015) A82eA416 A207 Physical activity was assessed between 2006 and 2008 by questionnaire, while low back pain and disability were assessed by the Chronic Pain Grade Scale at the time of MRI. Intervertebral disc height and cross-sectional area and fat content of multifidus and erector spinae were assessed from MRI. Results: Lower physical activity levels were associated with reduced average intervertebral disc height (b -0.63mm, 95% CI -1.17mm to -0.08mm, p 1⁄4 0.026) after adjusting for age, gender and BMI. There were no significant associations between physical activity levels and the cross-sectional area of multifidus or erector spinae. Lower levels of physical activity were associated with an increased risk of high fat content in multifidus (OR 2.7, 95% CI 1.1 to 6.7, p 1⁄4 0.04) and high intensity pain/disability (OR 1⁄4 5.0, 95% CI 1.5 to 16.4, p 1⁄4 0.008) after adjustment for age, gender and BMI. Conclusions: Physical inactivity is associated with reduced intervertebral disc height, high fat content of multifidus and high intensity low back pain and disability in a dose-dependent manner. These data provide evidence that among community-based adults, physical inactivity is associated with deleterious changes in lumbosacral spine structure. 331 THE ASSOCIATIONS BETWEEN DISC DEGENERATION AND COEXISTENT STRUCTURAL ABNORMALITIES IN THE LUMBOSACRAL SPINE e A 3.0T MRI STUDY OF COMMUNITY-BASED ADULTS A. Teichtahl y, D. Urquhart z, Y. Wang z, A. Wluka z, R. O'Sullivan z, F. Cicuttini z. yBaker IDI/Monash Univ., Melbourne, Australia; zMonash Univ., Melbourne, Australia Purpose: Degenerative disc disease of the lumbar spine is common, with severe disease increasing the risk for back pain. This cross-sectional study examined whether disc degeneration was associated with structural pathology in the lumbosacral spine. Methods: 72 community-based individuals not selected for low back pain had MRI to determine lumbosacral disc degeneration via the Pfirrmann grading system, intervertebral disc height, Modic change and paraspinal muscle fat content. Results: With reducing intervertebral disc height, there was an increased prevalence of degenerative disc disease from L3 through to S1 (OR range 1.3 to 1.5; 95% CI range 1.1 to 2.1; all p 0.01). Modic change from L2 to L4 was associated with an increased prevalence of disc degeneration at each corresponding level (OR range 5.5 to 31.3, p 0.04). High fat (>50%) content of multifidus and erector spinae were associated with an increased prevalence of intervertebral disc degeneration at L5/S1 (OR 4.5, 95% CI 1.3 to 15.2, p 1⁄4 0.016) and L3/4 (OR 6.4, 95% CI 1.3 to 31.8, p 1⁄4 0.02) respectively, with a non-significant, but similar direction for all other lumbosacral levels. Conclusions: This cross-sectional study has demonstrated that reduced intervertebral disc height, Modic change and high fat content of the paraspinal muscles are associated with an increased prevalence of severe degenerative disc disease in the lumbosacral spine. Longitudinal studies are required to help determine whether degenerative disc disease is a cause or result of these structural abnormalities. 332 MODIC CHANGES IN THE LUMBAR SPINE AND THEIR ASSOCIATION WITH BODY COMPOSITION, FAT DISTRIBUTION AND INTERVERTEBRAL DISC HEIGHT e A 3.0T-MRI STUDY OF COMMUNITY-BASED ADULTS A. Teichtahl y, D. Urquhart z, Y. Wang z, A. Wluka z, R. O'Sullivan z, F. Cicuttini z. yBaker IDI/Monash Univ., Melbourne, Australia; zMonash Univ., Melbourne, Australia Purpose: Vertebral endplate and bone marrow (Modic) change are being recognised in the pathogenesis of non-specific low back pain. Although obesity, measured by the Bodymass index (BMI), has not been found to be associated with Modic change, body composition and fat distribution have not been examined. Moreover, no study has examined whether Modic change are related to other structural features of low back pain, such as reduced intervertebral disc height. Methods: 72 community-based individuals not selected for low back pain had lumbar vertebral Modic change and intervertebral disc height assessed from MRI. Dual energy x-ray absorptiometry measured body composition and fat distribution. Results: The predominance of Modic change was type 2, with only 1 participant demonstrating Modic type 1 change. Modic change was associated with an increased fat mass index (OR 1.20, 95% CI 1.01 to 1.43), and tended to be associated with a reduced fat-free mass index (OR 0.62, 95% CI 0.37 to 1.03, p1⁄4 0.07).While an increased percentage of gynoid fat was associated with a reduced risk (OR 0.62, 95% CI 0.43 to 0.89), an increased percentage of android fat was associated with an increased risk of Modic change (OR 2.11, 95% CI 1.18 to 3.76). Modic change was also associated with reduced intervertebral disc height at L2/3, L4/5 and L5/S1 (OR range 1.4 to 1.8; all p 0.03). Conclusions: Modic type 2 change is associated with reduced intervertebral disc height and an increased fat mass index. Whereas gynoid fat distribution protected against Modic type 2 change, an android pattern increased the risk of this lesion. Modic type 2 change, which histologically represent fat replacement, might have a metabolic component to its aetiology. Imaging: Joint Morphometry 333 BONE MARROW LESIONS QUANTITATIVELY EVALUATED ON FLUID SENSITIVE SEQUENCES, NOT CARTILAGE SEQUENCES, CORRELATE WITH PAIN: DATA FROM THE OSTEOARTHRITIS INITIATIVE M. Zhang y, J.B. Driban y, L. Price y, G.H. Lo z, T.E. McAlindon y. y Tufts Med. Ctr., Boston, MA, USA; zMichael E. DeBakey VA Med. Ctr./Baylor Coll. of Med., Houston, TX, USA Purpose: Subchondral bone marrow lesions (BMLs) are common findings on magnetic resonance (MR) images of knees with osteoarthritis (OA) and relate to structural and symptomatic progression of OA. While BMLs are often assessed on intermediate-weighted fat suppressed (IW FS) turbo spin echo sequences some researchers have also evaluated BMLs on 3-dimensional dual echo steady state (3D DESS) sequences or other similar sequences that are used for cartilage measurements. This latter approach would enable an efficient method to assess changes in BMLs and cartilage on the same sequence. Prior head-to-head comparisons have demonstrated that IW FS sequences may be more sensitive to detecting BMLs but have not determined if BMLs on the different sequences have similar construct validity. The purpose of this study was to compare quantitative assessment of BMLs on IW FS and 3D DESS sequences and to assess the construct validity of BML volumes on each sequence by calculating the correlations between BML volumes and knee Methods: We randomly chose 30 knees from the Osteoarthritis Initiative (OAI) with 24and 48-month MR images as well as complete data from the OAI Bone Ancillary Study (i.e., subchondral bone mineral density, MR-based trabecular morphometry, meniscal readings, and cartilage damage). Fifteen of these were randomly selected among those with medial joint space narrowing (OARSI score) between the 24and 48-month OAI visits and 15 knees had no medial joint space narrowing during this observation period. All of the knees had both IW FS and 3D DESS MRI images. The IW FS turbo spin echo and 3D DESS sequences were acquired using the OAI MR imaging protocol. We designed a semi-automatic software to measure BMLs on both sequences (Figure 1). One reader used customized software to place a large region of interest around a BML and the software generated the BML boundaries based on image morphology algorithms (image normalization, filtering, dilation, noise removal, and thresholding). We decided one threshold for IW FS and one threshold for 3D DESS based on 4 sample MRIs from each sequence. We summed the femur and tibia BMLs to generate a whole knee BML volume. We calculated the Spearman correlations of 24-month BML volume and BML volume change (48-month BMLsminus 24-month BMLs) between IW FS and 3D DESS sequences. We also calculated the association of BMLs on both sequences with Western Ontario and McMaster universities Arthritis index (WOMAC) pain score. Results: The IW FS sequence has larger BML volumes than 3D DESS sequence (24-month BMLs mean: IW FS 1⁄4 3507mm3, SD 1⁄4 5130mm3; 3D DESS 1⁄4 564.9mm3, SD 1⁄4 692.80mm3; Figures 2a and 2b). The difference in BML volumes between sequences is greater among knees with larger BMLs than knees with smaller BMLs (Figure 2b). The IW FS sequence generally demonstrates more BMLs volume change than 3D DESS sequence (Figure 2c and 2d). Furthermore, the difference between BML volume change between sequences is greater among knees with larger BML volume changes. The 24-month BML volume on IW FS is correlated with the 24-month BMLs volume on 3D DESS (r 1⁄4 0.90, p <

Prevalence and pattern of radiographic intervertebral disc degeneration in Vietnamese: a population-based study.

Intervertebral disc degeneration (IDD) is one of the most common skeletal disorders, yet few data are available in Asian populations. We sought to assess the prevalence and pattern of radiographic IDD in a Vietnamese population. This population-based cross-sectional investigation involved 170 men and 488 women aged ≥40 years, who were randomly sampled from the Ho Chi Minh City (Vietnam). Anthropometric data, clinical history and self-reported back and neck pain were ascertained by a questionnaire. Plain radiographs (from the cervical spine, thoracic spine to the lumbar spine) were examined for the presence of disc space narrowing and/or osteophytosis using the Kellgren-Lawrence (KL) grading system. The presence of radiographic IDD was defined if the KL grade was 2 or greater in at least one disc. The prevalence of radiographic IDD was 62.4% (n = 106) in men and 54.7% (n = 267) in women. The most frequently affected site was the lumbar spine with prevalence being 50.6 and 43.2% in men and women, respectively. The prevalence of IDD increased with advancing age: 18.8% among those aged 40-49 years, and increased to 83.4% in those aged ≥60 years. Self-reported neck pain and lower back pain were found in 30 and 44% of individuals, respectively. There was no statistically significant association between self-reported neck pain and cervical spine OA. These data suggest that radiographic IDD is highly prevalent in the Vietnamese population, and that self-reported back pain is not a sensitive indicator of IDD.

Injuries to the lower back in elite fast bowlers

In our study, the aims were to describe the changes in the appearance of the lumbar spine on MRI in elite fast bowlers during a follow-up period of one year, and to determine whether these could be used to predict the presence of a stress fracture of the posterior elements. We recruited 28 elite fast bowlers with a mean age of 19 years (16 to 24) who were training and playing competitively at the start of the study. They underwent baseline MRI (season 1) and further scanning (season 2) after one year to assess the appearance of the lumbar intervertebral discs and posterior bony elements. The incidence of low back pain and the amount of playing and training time lost were also recorded. In total, 15 of the 28 participants (53.6%) showed signs of acute bone stress on either the season 1 or season 2 MR scans and there was a strong correlation between these findings and the later development of a stress fracture (p < 0.001). The prevalence of intervertebral disc degeneration was relatively low. There was no relationship between disc degeneration on the season 1 MR scans and subsequent stress fracture. Regular lumbar MR scans of asymptomatic elite fast bowlers may be of value in detecting early changes of bone stress and may allow prompt intervention aimed at preventing a stress fracture and avoiding prolonged absence from cricket.