Typical MRI patterns of lumbar disc degeneration in young and middle-aged men   — The International Society for the Study of the Lumbar Spine
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Typical MRI patterns of lumbar disc degeneration in young and middle-aged men   (#1036)

Niko Murto 1 , Raili Raininko 2 , Ritva Luukkonen 3 , Päivi Leino-Arjas 3 , Katariina Luoma 1 4
  1. Department of Radiology, Helsinki University Central Hospital, Helsinki, Finland
  2. Department of Radiology, University of Uppsala, Uppsala, Sweden
  3. Finnish Institute of Occupational Health, Helsinki, Finland
  4. University of Helsinki, Helsinki, Finland

Introduction:

Intervertebral disc degeneration (DD) is regarded as a significant contributory factor to low back pain1. Most grading systems for lumbar DD base on signal intensity (SI) of the nucleus pulposus (NP) on T2-weighted MRI or combinations of SI with disc height and distinction of the border between NP and annulus fibrosus (AF)2,3. Same DD grading is usually used for all disc levels and ages of subjects. Knowledge about co-occurrence of DD findings in different disc levels and ages is lacking. Histologically found signs of early degeneration, such as focally increasing fibrosis horizontally in the middle of nuclear complex, intranuclear cleft (INC), and infolding of the inner fibrils of AF4–6 are detectable on MRI even without decrease of SI of the NP5.  Our aim is to use a detailed visual MRI classification including early DD findings to find typical age and disc level dependent MRI patterns that could be references to find the pathologic patterns.

Methods:

We evaluated MRI changes in lumbar discs, endplates, and subchondral bone of vertebrae of 26 young men and 164 middle-aged men with a detailed visual grading system to study co-occurrence of various findings and difference of typical disc patterns between two age groups. Prevalence of every grade of each DD variable at each disc level was calculated separately in both age groups. Variables with the strongest differences between age groups were further analysed, observing prevalence of different DD findings of those variables and the combinations of various findings together.

Results:

We found a wide variation in combinations of MRI findings in both age groups, but different combinations were common in the middle-aged than young men (Figure). The strongest differences between the age groups were found at the levels L2/L3 and L3/L4, in patterns including SI of the NP, inhomogeneity of SI of the NP, INC, diameter of the nuclear complex and inhomogeneity of the AF (Figure).

Discussion:

We suggest detailed assessment of anatomic disc structures including INC and nuclear complex when classifying DD on MRI. Differences between young and middle-aged were most remarkable in L2/L3 and L3/L4 discs, which degenerate later and slower than lower lumbar discs7. It seems reasonable to analyse specific regions of the intervertebral disc separately by disc level and compare those findings with typical patterns in that age when classifying lumbar DD on MRI.

618e8689527b0-Fig2b.png

Figure a illustrates a common combination of MRI findings found in young men: small nuclear complex; bright, homogenous NP with thin, grey INC and homogeneous, dark lamellar structure of AF. Figure b illustrates a common combination of MRI findings found in middle-aged men: large nuclear complex; slightly decreased SI of the NP with regular dense, dark INC and inhomogeneous, irregular AF.

 

 

 
  1. Brinjikji W, Diehn FE, Jarvik JG, et al. MRI findings of disc degeneration are more prevalent in adults with low back pain than in asymptomatic controls: A systematic review and meta-analysis. American Journal of Neuroradiology 2015;36:2394–9.
  2. Pfirrmann CWA, Metzdorf A, Zanetti M, et al. Magnetic Resonance Classification of Lumbar Intervertebral Disc Degeneration. Spine 2001;26:1873–8.
  3. Griffith JF, Wang Y-XJ, Antonio GE, et al. Modified Pfirrmann grading system for lumbar intervertebral disc degeneration. Spine 2007;32:E708-12.
  4. Wagner M, Sether LA, Yu S, et al. Age changes in the lumbar intervertebral disc studied with magnetic resonance and cryomicrotomy. Clinical Anatomy 1988;1:93–103
  5. Schiebler ML, Camerino VJ, Fallon MD, et al. In vivo and ex vivo magnetic resonance imaging evaluation of early disc degeneration with histopathologic correlation. Spine 1991;16:635–40.
  6. Yu SW, Haughton VM, Ho PS, et al. Progressive and regressive changes in the nucleus pulposus. Part II. The adult. Radiology 1988;169:93–7.
  7. Miller JA, Schmatz C, Schultz AB. Lumbar disc degeneration: correlation with age, sex, and spine level in 600 autopsy specimens. Spine 1988;13:173–8.
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