Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging.
TL;DR: Signal intensity changes appear to reflect a spectrum of vertebral body marrow changes associated with degenerative disk disease in patients referred for lumbar spine MR imaging.
Abstract: The authors reviewed magnetic resonance (MR) images of 474 consecutive patients referred for lumbar spine MR imaging. Type 1 changes (decreased signal intensity on T1-weighted spin-echo images and increased signal intensity on T2-weighted images) were identified in 20 patients (4%) and type 2 (increased signal intensity on T1-weighted images and isointense or slightly increased signal intensity on T2-weighted images) in 77 patients (16%). In all cases there was evidence of associated degenerative disk disease at the level of involvement. Histopathologic sections in three cases of type 1 change demonstrated disruption and fissuring of the end plates and vascularized fibrous tissue, while in three cases of type 2 change they demonstrated yellow marrow replacement. In addition, 16 patients with end-plate changes documented with MR were studied longitudinally. Type 1 changes in five of six patients converted to a type 2 pattern in 14 months to 3 years. Type 2 changes in ten patients remained stable over a 2-3...
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TL;DR: Disc degeneration can be graded reliably on routine T2-weighted magnetic resonance images using the grading system and algorithm presented in this investigation.
Abstract: Study design A reliability study was conducted Objectives To develop a classification system for lumbar disc degeneration based on routine magnetic resonance imaging, to investigate the applicability of a simple algorithm, and to assess the reliability of this classification system Summary of background data A standardized nomenclature in the assessment of disc abnormalities is a prerequisite for a comparison of data from different investigations The reliability of the assessment has a crucial influence on the validity of the data Grading systems of disc degeneration based on state of the art magnetic resonance imaging and corresponding reproducibility studies currently are sparse Methods A grading system for lumbar disc degeneration was developed on the basis of the literature An algorithm to assess the grading was developed and optimized by reviewing lumbar magnetic resonance examinations The reliability of the algorithm in depicting intervertebral disc alterations was tested on the magnetic resonance images of 300 lumbar intervertebral discs in 60 patients (33 men and 27 women) with a mean age of 40 years (range, 10-83 years) All scans were analyzed independently by three observers Intra- and interobserver reliabilities were assessed by calculating kappa statistics Results There were 14 Grade I, 82 Grade II, 72 Grade III, 68 Grade IV, and 64 Grade V discs The kappa coefficients for intra- and interobserver agreement were substantial to excellent: intraobserver (kappa range, 084-090) and interobserver (kappa range, 069-081) Complete agreement was obtained, on the average, in 838% of all the discs A difference of one grade occurred in 159% and a difference of two or more grades in 13% of all the cases Conclusion Disc degeneration can be graded reliably on routine T2-weighted magnetic resonance images using the grading system and algorithm presented in this investigation
3,048 citations
Cites methods from "Degenerative disk disease: assessme..."
...Changes in the vertebral body marrow adjacent to the intervertebral disc were not included in this algorithm because they can be well characterized by the three types that Modic et al suggested.(15) The current authors suggest Figure 1....
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TL;DR: In this article, the levels of production of interleukin-6 (IL-6), IL-8, and prostaglandin E2 (PGE2) were found in disc tissue from patients undergoing discectomy for sciatica (63) with patients undergoing fusion for discogenic low back pain (20) using an enzyme-linked immunoabsorbent assay.
Abstract: Herniated intervertebral disc tissue has been shown to produce a number of proinflammatory mediators and cytokines, but there have been no similar studies using discs from patients with discogenic low back pain. We have compared the levels of production of interleukin-6 (IL-6), interleukin-8 (IL-8) and prostaglandin E2 (PGE2) in disc tissue from patients undergoing discectomy for sciatica (63) with that from patients undergoing fusion for discogenic low back pain (20) using an enzyme-linked immunoabsorbent assay. There was a statistically significant difference between levels of production of IL-6 and IL-8 in the sciatica and low back pain groups (p < 0.006 and p < 0.003, respectively). The high levels of proinflammatory mediator found in disc tissue from patients undergoing fusion suggest that production of proinflammatory mediators within the nucleus pulposus may be a major factor in the genesis of a painful lumbar disc.
636 citations
TL;DR: Understanding the relationship of etiologic factors, the morphologic alterations, which can be characterized with imaging, and the mechanisms of pain production and their interactions in the production of symptoms will require more accurate and reproducible stratification of patient cohorts.
Abstract: The sequelae of disk degeneration are among the leading causes of functional incapacity in both sexes and are a common source of chronic disability in the working years Disk degeneration involves structural disruption and cell-mediated changes in composition Mechanical, traumatic, nutritional, and genetic factors all may play a role in the cascade of disk degeneration, albeit to variable degree in different individuals The presence of degenerative change is by no means an indicator of symptoms, and there is a very high prevalence in asymptomatic individuals The etiology of pain as the symptom of degenerative disease is complex and appears to be a combination of mechanical deformation and the presence of inflammatory mediators The role of imaging is to provide accurate morphologic information and influence therapeutic decision making A necessary component, which connects these two purposes, is accurate natural history data Understanding the relationship of etiologic factors, the morphologic alterati
430 citations
TL;DR: Most degenerative disc “abnormalities” were moderately associated with LBP and the strongest associations were noted for Modic changes and anterolisthesis.
Abstract: Study design Cross-sectional cohort study of a general population. Objective To investigate "abnormal" lumbar spine magnetic resonance imaging (MRI) findings, and their prevalence and associations with low back pain (LBP). Summary of background data The clinical relevance of various "abnormal" findings in the lumbar spine is unclear. Distinguishing between inevitable age-related findings and degenerative findings with deleterious consequences is a challenge. Methods Lumbar spine MRI was obtained in 412, 40-year-old individuals. Predefined "abnormal" MRI findings were interpreted without any knowledge of patient symptoms. Associations between MRI abnormalities and LBP were calculated using odds ratios. The "overall picture" of each MRI finding was established on the basis of the frequencies, diagnostic values, and the strength and consistency of associations. Results Most "abnormal" MRI findings were found at the lowest lumbar levels. Irregular nucleus shape and reduced disc height were common (>50% of individuals). Relatively common (25% to 50%) were hypointense disc signal, anular tears, high intensity zones, disc protrusions, endplate changes, zygapophyseal joint degeneration, asymmetry, and foraminal stenosis. Nerve root compromise, Modic changes, central spinal stenosis, and anterolisthesis/retrolisthesis were rare ( 4). Significantly positive associations with all LBP variables were seen for hypointense disc signals, reduced disc height, and Modic changes. All disc "abnormalities" except protrusion were moderately associated with LBP during the past year. Conclusion Most degenerative disc "abnormalities" were moderately associated with LBP. The strongest associations were noted for Modic changes and anterolisthesis. Further studies are needed to define clinical relevance.
405 citations
TL;DR: Modern discography techniques using small gauge needle and limited pressurization resulted in accelerated disc degeneration, disc herniation, loss of disc height and signal and the development of reactive endplate changes compared to match-controls.
Abstract: Study Design. Prospective, match-cohort study of disc degeneration progression over 10 years with and without baseline discography. Objectives. To compare progression of common degenerative findings between lumbar discs injected 10 years earlier with those same disc levels in matched subjects not exposed to discography. Summary of Background Data. Experimental disc puncture in animal and in vivo studies have demonstrated accelerated disc degeneration. Whether intradiscal diagnostic or treatment procedures used in clinical practice causes any damage to the punctured discs over time is currently unknown. Methods. Seventy-five subjects without serious low back pain illness underwent a protocol MRI and an L3/4, L4/5, and L5/S1 discography examination in 1997. A matched group was enrolled at the same time and underwent the same protocol MRI examination. Subjects were followed for 10 years. At 7 to 10 years after baseline assessment, eligible discography and controlled subjects underwent another protocol MRI examination. MRI graders, blind to group designation, scored both groups for qualitative findings (Pfirrmann grade, herniations, endplate changes, and high intensity zone). Loss of disc height and loss of disc signal were measured by quantitative methods. Results. Well matched cohorts, including 50 discography subjects and 52 control subjects, were contacted and met eligibility criteria for follow-up evaluation. In all graded or measured parameters, discs that had been exposed to puncture and injection had greater progression of degenerative findings compared to control (noninjected) discs: progression of disc degeneration, 54 discs (35%) in the discography group compared to 21 (14%) in the control group (P = 0.03); 55 new disc herniations in the discography group compared to 22 in the control group (P = 0.0003). New disc herniations were disproportionately found on the side of the anular puncture (P = 0.0006). The quantitative measures of disc height and disc signal also showed significantly greater loss of disc height (P = 0.05) and signal intensity (P = 0.001) in the discography disc compared to the control disc. Conclusion. Modern discography techniques using small gauge needle and limited pressurization resulted in accelerated disc degeneration, disc herniation, loss of disc height and signal and the development of reactive endplate changes compared to match-controls. Careful consideration of risk and benefit should be used in recommending procedures involving disc injection.
396 citations
Cites methods from "Degenerative disk disease: assessme..."
...The type of endplate marrow abnormality was designated using the Modic classification for simplicity of reference.(28) Each vertebral level was scored by the dominant Modic change....
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