MRI and discography of annular tears and intervertebral disc degeneration. A prospective clinical comparison

Osti, OL; Fraser, Robert D.

doi:10.1302/0301-620x.74b3.1587896

Cited by 109 publications

(37 citation statements)

References 14 publications

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“…While MRI has become the standard noninvasive tool to assess degeneration of the intervertebral disc, debate continues on the specific criteria and potential quantification. Osti and Fraser 31 suggested using a semiquantitative assessment of signal intensity. Frobin et al 10 used endplate .…”

Section: Discussionmentioning

confidence: 99%

Effect of aging and degeneration on disc volume and shape: A quantitative study in asymptomatic volunteers

Pfirrmann

Metzdorf

Elfering

et al. 2006

Journal Orthopaedic Research

128

105

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Debate continues on the effect of disc degeneration and aging on disc volume and shape. So far, no quantitative in vivo MRI data is available on the factors influencing disc volume and shape. The objective of this MRI study was to quantitatively investigate changes in disc height, volume, and shape as a result of aging and/or degeneration omitting pathologic (i.e., painful) disc alterations. Seventy asymptomatic volunteers (20-78 years) were investigated with sagittal T1-and T2-weighted MR-images encompassing the whole lumbar spine. Disc height was determined by the Dabbs method and the Farfan index. Disc volume was calculated by the Cavalieri method. For the disc shape the ''disc convexity index'' was calculated by the ratio of central disc height and mean anterior/posterior disc height. Disc height, disc volume, and the disc convexity index measurements were corrected for disc level and the individuals age, weight, height, and sex in a multilevel regression analysis. Multilevel regression analysis showed that disc volume was negatively influenced by disc degeneration ( p < 0.001) and positively correlated with body height ( p < 0.001) and age ( p < 0.01). Mean disc height and the disc convexity index were negatively influenced by disc degeneration but not by gender, weight, and height. Disc height was positively correlated with age ( p < 0.01). From the results of this study, it can be concluded that disc degeneration generally results in a decrease of disc height and volume as well as a less convex disc shape. In the absence of disc degeneration, however, age tends to result in an inverse relationship on disc height, volume, and shape. ß

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Section: Discussionmentioning

confidence: 99%

Effect of aging and degeneration on disc volume and shape: A quantitative study in asymptomatic volunteers

Pfirrmann

Metzdorf

Elfering

et al. 2006

Journal Orthopaedic Research

128

105

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“…Several studies have attempted to correlate the MRI features of disc degeneration (reduced SI on T2-weighted sequences and disc bulge) with pain reproduction at discography [11,17,22]. Although MRI was found to be sensitive for the identification of degenerative discs, it was unreliable at identifying which disc was the source of pain.…”

Section: Discussionmentioning

confidence: 99%

“…bility therefore arises that Modic changes are in some cases the result of chemical inflammation from degenerative discs and may be a secondary sign on MRI of "internal disc disruption" and discogenic low back pain. Previous studies have tried to correlate disc degeneration and the high-intensity zone (HIZ) on MRI with pain reproduction at lumbar discography, with variable results [1,5,11,16,17,[19][20][21][22]. The aim of the present study was to correlate the presence of Modic changes with pain reproduction at lumbar discography, in a group of patients with a clinical diagnosis of discogenic low back pain.…”

Section: Introductionmentioning

confidence: 99%

Vertebral end-plate (Modic) changes on lumbar spine MRI: correlation with pain reproduction at lumbar discography

Braithwaite

White

Saifuddin

et al. 1998

European Spine Journal

303

200

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IntroductionVertebral end-plate (Modic) changes were first described independently by de Roos et al. [9] and Modic et al. [15] as being a feature associated with degenerative intervertebral disc disease. Type I changes consist of reduced signal intensity (SI) in the vertebral end-plates on T1-and increased SI on T2-weighted sequences (Fig. 1). They are associated with fissuring of the cartilaginous end-plate and increased vascularity within the subchondral bone marrow on histological examination. Type II changes consist of increased SI on T1-and either increased SI or isointensity on T2-weighted sequences (Fig. 2). In such cases, biopsy reveals fatty replacement of the marrow [15], which is thought to be the result of marrow ischaemia [9]. Type III changes consist of reduced SI on both T1-and T2-weighted sequences due to subchondral sclerosis ( Fig. 3). Type I changes commonly progress to Type II changes and rarely revert back to normal, whereas Type II changes appear not to change with time [15]. Modic changes are identified in 20-50% of patients, with the incidence increasing with age [9,15]. However, it is not known why some degenerative discs are associated with Modic changes while others are not.Crock [6,7] proposed the concept of "internal disc disruption", suggesting that repeated trauma to the intervertebral disc could result in the production of inflammatory substances within the nucleus pulposus. Diffusion of such toxic chemicals through the vertebral end-plate could then result in a local inflammatory reaction resulting in back pain.Inflammation in the subchondral bone adjacent to the end-plate would result in reduced SI on T1-weighted MRI sequences and increased SI on T2-weighted MRI sequences, equivalent to a Type 1 Modic change. The possiAbstract The vertebral end-plate has been identified as a possible source of discogenic low back pain. MRI demonstrates end-plate (Modic) changes in 20-50% of patients with low back pain. The aim of this study was to investigate the association between Modic changes on MRI and discogenic back pain on lumbar discography. The MRI studies and discograms of 58 patients with a clinical diagnosis of discogenic back pain were reviewed and the presence of a Modic change was correlated with pain reproduction at 152 disc levels. Twenty-three discs with adjacent Modic changes were injected, 21 of which were associated with pain reproduction. However, pain was also reproduced at 69 levels where no Modic change was seen. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for a Modic change as a marker of a painful disc were 23.3%, 96.8%, 91.3% and 46.5% respectively. Modic changes, therefore, appear to be a relatively specific but insensitive sign of a painful lumbar disc in patients with discogenic low back pain.

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“…During discography typical pain reproduction has been noticed to associate with annular tears extending to the outer annulus [16]. None of the discograms showing normal morphology reproduced the patients' typical pain [16].…”

Section: Introductionmentioning

confidence: 95%

Growth factor expression in degenerated intervertebral disc tissue

et al. 2005

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MRI and discography of annular tears and intervertebral disc degeneration. A prospective clinical comparison

Cited by 109 publications

References 14 publications

Effect of aging and degeneration on disc volume and shape: A quantitative study in asymptomatic volunteers

Effect of aging and degeneration on disc volume and shape: A quantitative study in asymptomatic volunteers

Vertebral end-plate (Modic) changes on lumbar spine MRI: correlation with pain reproduction at lumbar discography

Growth factor expression in degenerated intervertebral disc tissue

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