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Temporal Interactions of Degenerative Changes in Individual Components of the Lumbar Intervertebral Discs: A Sequential Magnetic Resonance Imaging Study in Patients Less Than 40 Years of Age

Sharma, Aseem MD*,†,‡; Parsons, Matthew MD*,†,‡; Pilgram, Thomas PhD*

doi: 10.1097/BRS.0b013e31821590ad

Study Design. A retrospective longitudinal observational study using baseline and follow-up magnetic resonance imaging (MRI).

Objective. To study the natural history of disc degeneration, focusing on the significance of changes affecting the individual components of the intervertebral disc.

Summary of Background Data. The natural history of the degenerative disc disease is poorly understood. Focusing on the relative prevalence, temporal evolution, and interactions of pathology in the anulus fibrosus, nucleus pulposus, and the end plates can help in better understanding of this process.

Methods. MRIs of the lumbar spine in 63 patients, obtained at a mean interval of 30 months, were evaluated independently by two neuroradiologists to assess the temporal evolution of degeneration changes in 378 discs between T12 through S1 segments. In addition, a direct side-by-side comparison of two studies was also performed. Statistical analysis was performed to assess the association between the degeneration of individual disc components and to find the predictors of future degeneration.

Results. Radial anular tears and end plate defects were associated with worse nuclear degeneration at the time of the initial study. Both end plate defects and nuclear degeneration were rare in the absence of radial tears. Multiple nominal logistic regression analysis showed that radial tears and herniation at the time of the initial study, along with the duration between the two imaging studies were the significant predictors of worsening nuclear degeneration. Age, sex, and the segmental disc level did not show any significant association with temporal progression of nuclear degeneration.

Conclusion. Radial tears and herniation are significant predictors of progressive nuclear degeneration, which was not seen in the absence of radial tears. End plate defects also frequently occur before nuclear degeneration but rarely in the absence of anular tears.

A retrospective observational longitudinal study of 378 intervertebral discs was done with MR imaging. The discs were assessed for annular tears, disc desiccation, and degeneration. Radial tears and herniation were significantly associated with nuclear degeneration and were a significant predictor of progressive nuclear degeneration.

*Mallinckrodt Institute of Radiology, Washington University School of Medicine;

Department of Radiology, Barnes-Jewish Hospital;

Department of Radiology, St Louis Children's Hospital, St Louis, MO.

Address correspondence and reprint requests to Aseem Sharma, MD, Mallinckrodt Institute of Radiology, Washington University School of Medicine, Campus Box 8131, 510 S Kingshighway Blvd, St Louis, MO 63110; E-mail:

Acknowledgment date: October 18, 2010. Revision date: January 14, 2011. Acceptance date: February 4, 2011.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

© 2011 Lippincott Williams & Wilkins, Inc.