Purpose:

Intradiscal vacuum phenomenon (IDVP), despite being ubiquitous, is poorly understood. The dynamic passage of peri-discal gases into the degenerated disc is a commonly accepted theory. But the reasons behind its selective appearance in some discs is unevaluated.

Methods:

721 patients with chronic low back pain ± radiculopathy, were evaluated with AP and flexion-extension lateral radiographs and MRI. IDVP was classified based on its morphology and location. Radiographic parameters including sagittal translation, sagittal angulation, lateral listhesis, eccentric disc collapse, Pfirrmann’s grade, disc height, Modic changes, anterior longitudinal ligament status and primary spinal disease at the level of IDVP was analyzed.

Results:

342 patients had IDVP, and had a higher mean age (57.2±12.5 years) than controls (p <0.001). Eccentric disc space narrowing (26.5% vs 1.3%, p<0.01), coronal listhesis (7.83% vs 1.1%, p <0.001), sagittal angular motion difference (11.3±4.6°, p<0.001), higher mean disc degeneration (4.36±0.69, p<0.001), ALL disruption (30.3% vs 2.2%, p<0.001) and Modic changes (88.6% vs 17.5%, p<0.001) were significantly higher in IDVP discs (vs non-IDVP). Binary logistic regression analysis indicated sagittal angular motion difference was the most predictive factor. IDVP was classified into three types - dense type (47.5%), linear (29.5%), dot type (23%). Dense type matched radiological correlations of IDVP while dot types behaved like non-IDVP discs.

Conclusion:

Modic disc-endplate contacts, ALL disruption and coronal translation could be pathways for passage of peri-discal gases into the degenerated disc. In the pathogenesis of IDVP, advanced disc degeneration, presence of pathways of gas transfer and angular/coronal instability seem to play complimentary roles.

Figure showing the Morphological classification of Intra-discal Vacuum Phenomenon