Degeneration of the cervical disc: histology compared with radiography and magnetic resonance imaging

Abstract

Decisions about the treatment of neck pain are largely made on the basis of information gained from plain X-rays and magnetic resonance imaging (MRI), which are used routinely as part of preliminary investigation. We performed a descriptive cadaveric study to compare histology with radiography and MRI. We correlated plain radiography, disc height [Farfan index (FI)] and MRI findings with histology to assess the ability of radiology to detect significant pathologic lesions. The study included 52 motion segments from nine subjects over the age of 50, who underwent routine hospital autopsy. Disc degeneration was assessed by histology, radiography, disc height (FI: anterior disc height plus posterior disc height divided by anterioposterior diameter) and MRI using established grading systems. Most of the discs were classified radiologically as grade 1 (19/52), grade 2 (13/52), grade 3 (9/52) or grade 4 (3/52). Eight of the discs were graded as normal. The distribution of MRI grades was grade 0 (9/36), grade 1 (9/36), grade 2 (7/36), grade 3 (8/36) and grade 4 (3/36). Half of the discs (26/52) showed advanced (grade 4) degeneration histologically. FI correlated with histological grade (P = 0.013), MRI grade (P = 0.02) and radiological grade (P < 0.001) of degeneration. Radiological and histological grade of degeneration showed a weak correlation (r = 0.3, P = 0.033). MRI correlated with overall histological grade (r = 0.41, P = 0.015, n = 34). Histological features (e.g., tears, rim lesions, prolapse of nucleus material) were poorly recognised by MRI, which had a sensitivity for disc material prolapse and annulus tears of less than 40%. Our study showed that discs from patients over 50 years are histologically severely degenerated; however, these changes may not be detected by conventional radiography and MRI.

Immuohistochemical score of matrix metalloproteinase-1 may indicate the severity of symptomatic cervical and lumbar disc degeneration

“…Previous reports disclosed a lack of correlation between MRI/MCs scale and HDS [36,37]. Possible explanations for this finding are as follows: (1) sampling discrepancy, expected to be obvious in cases involving the lumbar spine because the protruded portion, rather than the whole disc, is removed; (2) use of qualitative and less complex grading criteria to obtain MRI/MCs scale [22]; (3) dehydration of the IVD detected on MRI (based on T2-weighted protocols) may simply represent the aging process rather than pathological IVD degeneration [38,39]; (4) fissures and cell clusters within the IVD seen under a microscope may not be detected with current MRI methodologies [24].…”

“…The broad scope of MMP function expands their potential role as activators or inhibitors of tissue remodeling, with effects in the context of cardiovascular disease and obesity [15]. Currently, 24 MMPs have been recognized in humans. These are categorized into six groups: collagenases, gelatinases, stromelysins, matrilysins, membrane-type MMPs, and other types [16].…”

“…The second, Modic changes (MCs; defined by Modic et al), is based on degenerative endplate changes [23]. Nonetheless, microscopic assessment of IVD tissue has been considered the most sensitive method of identifying features of IVD degeneration [24,25]. Boos et al developed a classification system based on the quantitative assessment of histologic disc changes in a study that included a postmortem cohort and a small series of surgical samples [26].…”

Prevalence of Disc Degeneration in Asymptomatic Korean Subjects. Part 2 : Cervical Spine

“…However, cervical disc degeneration is frequently found on MRI, even in the absence of neck pain. Christe et al5) reported that disc herniation (above of bulging) was found in 30.6% of asymptomatic subjects.…”

Sensitivity of magnetic resonance imaging in the diagnosis of mobile and nonmobile L4–L5 degenerative spondylolisthesis

“…Mobile spondylolisthesis was defined as a greater than 3% difference in slip percentage when comparing standing lateral radiographs with MRIs, as has been previously reported [10]. Disc height was assessed by anterior and posterior heights and the Farfan index was calculated by dividing the sum of the anterior and posterior heights by the disc width [9,18]. Facet effusion was determined by measuring the effusion width orthogonal to the facet joint [4,10].…”