Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Prevalence of Disc Degeneration in Asymptomatic Korean Subjects. Part 1 : Lumbar Spine

  • Kim, Sang Jin (Department of Neurosurgery, Ewha Womans University School of Medicine, Mokdong Hospital) ;
  • Lee, Tae Hoon (Department of Neurosurgery, 21st Century Hospital) ;
  • Lim, Soo Mee (Department of Radiology, Ewha Womans University School of Medicine, Mokdong Hospital)
  • Received : 2012.06.13
  • Accepted : 2013.01.15
  • Published : 2013.01.28
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : Asymptomatic patients show high degeneration prevalence at lumbar disc in previous literatures. Unfortunately, there are few Korean data, so the authors attempted to analyze the prevalence of disc degeneration in highly selective asymptomatic Korean subjects using MRI. Methods : We performed 3 T MRI sagittal scans from T12 to S1 on 102 asymptomatic subjects (50 men and 52 women) who visited our hospital between the ages of 14 and 82 years (mean age 46.3 years). All images were read independently by three observers (two neurosurgeons and one neuroradiologist) who were not given any information about the subjects. We classified grading for lumbar disc herniation (HN), annular fissure (AF), and nucleus degeneration (ND), using disc degeneration classification. Results : The prevalence of HN, AF, and ND were 81.4%, 76.1%, and 75.8% respectively. Almost all levels showed an age-related proportional tendency with some exceptions. Conclusion : In asymptomatic Korean subjects, the abnormal findings showed high prevalence of AF, ND, and extrusion. Especially in young ages, the authors found that bulging, protrusion, and AF showed high prevalence at L4/5 and L5/S1. And ND showed high prevalence at L5/S1. So, all lumbar disc degenerations are not pathologic, especially in children and adolescents.

Keywords

References

  1. Aprill C, Bogduk N : High-intensity zone : a diagnostic sign of painful lumbar disc on magnetic resonance imaging. Br J Radiol 65 : 361-369, 1992 https://doi.org/10.1259/0007-1285-65-773-361
  2. Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW : Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am 72 : 403-408, 1990 https://doi.org/10.2106/00004623-199072030-00013
  3. Boden SD, McCowin PR, Davis DO, Dina TS, Mark AS, Wiesel S : Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am 72 : 1178-1184, 1990 https://doi.org/10.2106/00004623-199072080-00008
  4. Boos N, Rieder R, Schade V, Spratt KF, Semmer N, Aebi M : 1995 Volvo Award in clinical sciences. The diagnostic accuracy of magnetic resonance imaging, work perception, and psychosocial factors in identifying symptomatic disc herniations. Spine (Phila Pa 1976) 20 : 2613-2625, 1995 https://doi.org/10.1097/00007632-199512150-00002
  5. Boos N, Semmer N, Elfering A, Schade V, Gal I, Zanetti M, et al. : Natural history of individuals with asymptomatic disc abnormalities in magnetic resonance imaging : predictors of low back pain-related medical consultation and work incapacity. Spine (Phila Pa 1976) 25 : 1484-1492, 2000 https://doi.org/10.1097/00007632-200006150-00006
  6. Borenstein DG, O'Mara JW Jr, Boden SD, Lauerman WC, Jacobson A, Platenberg C, et al. : The value of magnetic resonance imaging of the lumbar spine to predict low-back pain in asymptomatic subjects : a seven-year follow-up study. J Bone Joint Surg Am 83A : 1306-1311, 2001
  7. Brant-Zawadzki MN, Jensen MC, Obuchowski N, Ross JS, Modic MT : Interobserver and intraobserver variability in interpretation of lumbar disc abnormalities. A comparison of two nomenclatures. Spine (Phila Pa 1976) 20 : 1257-1263; discussion 1264, 1995 https://doi.org/10.1097/00007632-199506000-00010
  8. Brown BM, Schwartz RH, Frank E, Blank NK : Preoperative evaluation of cervical radiculopathy and myelopathy by surface-coil MR imaging. AJR Am J Roentgenol 151 : 1205-1212, 1988 https://doi.org/10.2214/ajr.151.6.1205
  9. Buirski G, Silberstein M : The symptomatic lumbar disc in patients with low-back pain. Magnetic resonance imaging appearances in both a symptomatic and control population. Spine (Phila Pa 1976) 18 : 1808-1811, 1993 https://doi.org/10.1097/00007632-199310000-00016
  10. Carragee EJ, Paragioudakis SJ, Khurana S : 2000 Volvo Award winner in clinical studies : Lumbar high-intensity zone and discography in subjects without low back problems. Spine (Phila Pa 1976) 25 : 2987-2992, 2000 https://doi.org/10.1097/00007632-200012010-00005
  11. Cho KH : Physical therapy and pharmacological treatment of lumbar disc herniations. J Korean Med Assoc 47 : 827-843, 2004 https://doi.org/10.5124/jkma.2004.47.9.827
  12. Elfering A, Semmer N, Birkhofer D, Zanetti M, Hodler J, Boos N : Risk factors for lumbar disc degeneration : a 5-year prospective MRI study in asymptomatic individuals. Spine (Phila Pa 1976) 27 : 125-134, 2002 https://doi.org/10.1097/00007632-200201150-00002
  13. Fries P, Runge VM, Kirchin MA, Watkins DM, Buecker A, Schneider G : Magnetic resonance imaging of the spine at 3 Tesla. Semin Musculoskelet Radiol 12 : 238-252, 2008 https://doi.org/10.1055/s-0028-1083107
  14. Gibson MJ, Buckley J, Mawhinney R, Mulholland RC, Worthington BS : Magnetic resonance imaging and discography in the diagnosis of disc degeneration. A comparative study of 50 discs. J Bone Joint Surg Br 68 : 369-373, 1986
  15. Griffith JF, Wang YX, Antonio GE, Choi KC, Yu A, Ahuja AT, et al. : Modified Pfirrmann grading system for lumbar intervertebral disc degeneration. Spine (Phila Pa 1976) 32 : E708-E712, 2007 https://doi.org/10.1097/BRS.0b013e31815a59a0
  16. Harris RI, Macnab I : Structural changes in the lumbar intervertebral discs; their relationship to low back pain and sciatica. J Bone Joint Surg Br 36-B : 304-322, 1954 https://doi.org/10.1302/0301-620X.36B2.304
  17. Hitselberger WE, Witten RM : Abnormal myelograms in asymptomatic patients. J Neurosurg 28 : 204-206, 1968 https://doi.org/10.3171/jns.1968.28.3.0204
  18. Holt EP Jr : The question of lumbar discography. J Bone Joint Surg Am 50 : 720-726, 1968 https://doi.org/10.2106/00004623-196850040-00007
  19. Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS : Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med 331 : 69-73, 1994 https://doi.org/10.1056/NEJM199407143310201
  20. Lewinnek GE, Warfield CA : Facet joint degeneration as a cause of low back pain. Clin Orthop Relat Res : 216-222, 1986
  21. Maravilla KR, Lesh P, Weinreb JC, Selby DK, Mooney V : Magnetic resonance imaging of the lumbar spine with CT correlation. AJNR Am J Neuroradiol 6 : 237-245, 1985
  22. Masaryk TJ, Ross JS, Modic MT, Boumphrey F, Bohlman H, Wilber G : High-resolution MR imaging of sequestered lumbar intervertebral disks. AJR Am J Roentgenol 150 : 1155-1162, 1988 https://doi.org/10.2214/ajr.150.5.1155
  23. Mitra D, Cassar-Pullicino VN, McCall IW : Longitudinal study of vertebral type-1 end-plate changes on MR of the lumbar spine. Eur Radiol 14 : 1574-1581, 2004
  24. Modic MT, Masaryk TJ, Mulopulos GP, Bundschuh C, Han JS, Bohlman H : Cervical radiculopathy : prospective evaluation with surface coil MR imaging, CT with metrizamide, and metrizamide myelography. Radiology 161 : 753-759, 1986 https://doi.org/10.1148/radiology.161.3.3786728
  25. Modic MT, Masaryk TJ, Ross JS : Magnetic resonance imaging of the spine, ed 2. St. Louis : Mosby, 1994, pp82-119
  26. Osborn AG, Hood RS, Sherry RG, Smoker WR, Harnsberger HR : CT/MR spectrum of far lateral and anterior lumbosacral disk herniations. AJNR Am J Neuroradiol 9 : 775-778, 1988
  27. Schellhas KP, Pollei SR, Gundry CR, Heithoff KB : Lumbar disc high-intensity zone. Correlation of magnetic resonance imaging and discography. Spine (Phila Pa 1976) 21 : 79-86, 1996 https://doi.org/10.1097/00007632-199601010-00018
  28. Stadnik TW, Lee RR, Coen HL, Neirynck EC, Buisseret TS, Osteaux MJ : Annular tears and disk herniation : prevalence and contrast enhancement on MR images in the absence of low back pain or sciatica. Radiology 206 : 49-55, 1998 https://doi.org/10.1148/radiology.206.1.9423651
  29. Weishaupt D, Zanetti M, Hodler J, Boos N : MR imaging of the lumbar spine : prevalence of intervertebral disk extrusion and sequestration, nerve root compression, end plate abnormalities, and osteoarthritis of the facet joints in asymptomatic volunteers. Radiology 209 : 661-666, 1998 https://doi.org/10.1148/radiology.209.3.9844656
  30. Wenig CM, Schmidt CO, Kohlmann T, Schweikert B : Costs of back pain in Germany. Eur J Pain 13 : 280-286, 2009 https://doi.org/10.1016/j.ejpain.2008.04.005
  31. Wiesel SW, Tsourmas N, Feffer HL, Citrin CM, Patronas N : A study of computer-assisted tomography. I. The incidence of positive CAT scans in an asymptomatic group of patients. Spine (Phila Pa 1976) 9 : 549-551, 1984 https://doi.org/10.1097/00007632-198409000-00003
  32. Yasuma T, Makino E, Saito S, Inui M : Histological development of intervertebral disc herniation. J Bone Joint Surg Am 68 : 1066-1072, 1986 https://doi.org/10.2106/00004623-198668070-00015

Cited by

  1. Prevalence of Disc Degeneration in Asymptomatic Korean Subjects. Part 3 : Cervical and Lumbar Relationship vol.53, pp.3, 2013, https://doi.org/10.3340/jkns.2013.53.3.167
  2. Risk Factors for Lumbar Disc Degeneration in High School American Football Players : A Prospective 2-Year Follow-up Study vol.41, pp.9, 2013, https://doi.org/10.1177/0363546513495173
  3. Nonoperative interventions for spinal pain vol.57, pp.4, 2013, https://doi.org/10.5124/jkma.2014.57.4.308
  4. Changes in the Spinopelvic Parameters of Elite Weight Lifters vol.24, pp.4, 2013, https://doi.org/10.1097/jsm.0000000000000094
  5. Etiology and nature of intervertebral disc degeneration and its correlation with low back pain vol.4, pp.1, 2013, https://doi.org/10.7600/jpfsm.4.63
  6. Whole Spine Disc Degeneration Survey according to the Ages and Sex Using Pfirrmann Disc Degeneration Grades vol.14, pp.4, 2017, https://doi.org/10.14245/kjs.2017.14.4.148
  7. Degenerative Lumbar Spine Disease: Estimating Global Incidence and Worldwide Volume vol.8, pp.8, 2013, https://doi.org/10.1177/2192568218770769
  8. Can 5 minutes of repetitive prone press-ups and sustained prone press-ups following a period of spinal loading reverse spinal shrinkage? vol.35, pp.3, 2013, https://doi.org/10.1080/09593985.2018.1442539
  9. Treatment of patients with acute and subacute lumbodynia and lumbar ischialgia vol.11, pp.3, 2013, https://doi.org/10.14412/2074-2711-2019-3-57-62
  10. Comparative efficacy and tolerance of centrally acting muscle relaxants in elderly patients with nonspecific musculoskeletal pain vol.12, pp.1, 2013, https://doi.org/10.14412/2074-2711-2020-1-39-44
  11. Growing a backbone - functional biomaterials and structures for intervertebral disc (IVD) repair and regeneration: challenges, innovations, and future directions vol.8, pp.5, 2020, https://doi.org/10.1039/c9bm01288e
  12. Degenerative cervical myelopathy presenting as subjective lower limb weakness could be a trap towards misdiagnosis vol.10, pp.1, 2020, https://doi.org/10.1038/s41598-020-78139-y
  13. Lumbar Thecal Sac Dimensions and Axial Spinal Cord Areas on Magnetic Resosnace Imaging in 626 Healthy Subjects vol.46, pp.24, 2021, https://doi.org/10.1097/brs.0000000000004143
  14. Patterns of Lumbar Disc Degeneration: Magnetic Resonance Imaging Analysis in Symptomatic Subjects vol.15, pp.6, 2021, https://doi.org/10.31616/asj.2020.0325