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Abnormal Findings on Magnetic Resonance Images of the Cervical Spines in 1211 Asymptomatic Subjects

Nakashima, Hiroaki, MD; Yukawa, Yasutsugu, MD; Suda, Kota, MD; Yamagata, Masatsune, MD; Ueta, Takayoshi, MD; Kato, Fumihiko, MD

doi: 10.1097/BRS.0000000000000775

Study Design. Cross-sectional study.

Objective. The purpose of this study was to determine the prevalence and distribution of abnormal findings on cervical spine magnetic resonance image (MRI).

Summary of Background Data. Neurological symptoms and abnormal findings on MR images are keys to diagnose the spinal diseases. To determine the significance of MRI abnormalities, we must take into account the (1) frequency and (2) spectrum of structural abnormalities, which may be asymptomatic. However, no large-scale study has documented abnormal findings of the cervical spine on MR image in asymptomatic subjects.

Methods. MR images were analyzed for the anteroposterior spinal cord diameter, disc bulging diameter, and axial cross-sectional area of the spinal cord in 1211 healthy volunteers. The age of healthy volunteers prospectively enrolled in this study ranged from 20 to 70 years, with approximately 100 individuals per decade, per sex. These data were used to determine the spectrum and degree of disc bulging, spinal cord compression (SCC), and increased signal intensity changes in the spinal cord.

Results. Most subjects presented with disc bulging (87.6%), which significantly increased with age in terms of frequency, severity, and number of levels. Even most subjects in their 20s had bulging discs, with 73.3% and 78.0% of males and females, respectively. In contrast, few asymptomatic subjects were diagnosed with SCC (5.3%) or increased signal intensity (2.3%). These numbers increased with age, particularly after age 50 years. SCC mainly involved 1 level (58%) or 2 levels (38%), and predominantly occurred at C5–C6 (41%) and C6–C7 (27%).

Conclusion. Disc bulging was frequently observed in asymptomatic subjects, even including those in their 20s. The number of patients with minor disc bulging increased from age 20 to 50 years. In contrast, the frequency of SCC and increased signal intensity increased after age 50 years, and this was accompanied by increased severity of disc bulging.

Level of Evidence: 2

Cervical disc bulging, spinal cord compression, and increased signal intensity changes were evaluated on cervical magnetic resonance images of 1211 healthy volunteers. Disc bulging, spinal cord compression, and increased signal intensity were found in 87.6%, 5.3%, and 2.3% subjects, respectively. The frequency of spinal cord compression and increased signal intensity increased after age 50 years.

*Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Aichi, Japan

Department of Orthopedic Surgery, Chubu Rosai Hospital, Chubu, Japan

Department of Orthopedic Surgery, Hokkaido Chuo Rosai Hospital Sekison Center, Hokkaido, Japan

§Department of Orthopedic Surgery, Chiba Rosai Hospital, Chiba, Japan; and

Department of Orthopedic Surgery, Spinal Injuries Center, Fukuoka, Japan.

Address correspondence and reprint requests to Hiroaki Nakashima, MD, Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Shouwa-ku, Nagoya, Aichi 466-8560, Japan; E-mail:

Acknowledgment date: September 2, 2014. First revision date: November 27, 2014. Second revision date: December 15, 2014. Acceptance date: December 17, 2014.

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

Institutional funds and grant research funds, which are intended for promoting hospital functions, of the Japan Labor Health and Welfare Organization (Kawasaki, Japan) were received in support of this study.

No relevant financial activities outside the submitted work.

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