MRI changes of cervical spine in asymptomatic and symptomatic young adults

Abstract

IntroductionNeck and shoulder pain is a commonly encountered complaint in medical practice. In population studies, 20-65% of women and 15-40% of men have reported having experienced neck and shoulder symptoms during their lives [1,29]. The symptoms are also fairly common in adolescents, and may predict morbidity in adulthood [8]. It has been demonstrated that 15% of adolescents suffer from weekly neck and shoulder symptoms [19,28], the prevalence increases with age [28] and the symptoms among adolescents have increased during the last decade [21]. Neck and shoulder pain is thought to be multietiological. There is evidence to show that various work-related factors, such as repetitive tasks and working with the arms raised or the neck bent forward, are related to neck and shoulder pain [5,7]. Several psychosocial and individual factors, such as high requirements [26] or low personal control of work [2], work-related psychosocial stress [30], Abstract Several work-related, psychosocial and individual factors have been verified as being related to neck and shoulder pain, but the role of pathology visualized by magnetic resonance imaging (MRI) remains unclear. In this study, the relationship between neck and shoulder pain and cervical high-field MRI findings was investigated in a sample of persons in a longitudinal survey. The study aimed to determine whether subjects with persistent or recurrent neck and shoulder pain were more likely to have abnormal MRI findings of cervical spine than those without neck and shoulder pain. A random sample of 826 high-school students was investigated initially when the students were 17-19 years, and again when they had reached 24-26 years of age. Eighty-seven percent participated in the first survey in 1989, of whom 76% took part in the second survey, in 1996. The validated Nordic Musculoskeletal Questionnaire was used to collect data about neck and shoulder symptoms. Two groups were chosen for the MRI study: the first group (n=15) consisted of the participants who had reported no neck and shoulder symptoms in either of the inquiries, while the second group (n=16) comprised those who were suffering from neck and shoulder symptoms once a week or more often at the time of both surveys. The degrees of disc degeneration, anular tear, disc herniation and protrusion were assessed by two radiologists. The differences between the two study groups were evaluated. The study found that abnormal MRI findings were common in both study groups. Disc herniation was the only MRI finding that was significantly associated with neck pain. These findings indicate that pathophysiological changes of cervical spine verified on MRI seem to explain only part of the occurrence of neck and shoulder pain in young adults.

Relationship between Northwick Park neck pain questionnaire and cervical spine MR imaging findings

“…Degenerative disc disease was the only imaging finding that was almost significantly associated with higher NPQ score. This result agrees with a recent study of MR imaging of cervical spine, where extrusion was the only finding marginally associated with disability [31]. No other imaging finding was related to NPQ score.…”

“…The relation between symptoms, physical exploration and imaging is elusive [20,31]. The definitions of neck pain and the period of the assessment vary and, consequently, so do the reported prevalence figures [6].…”

“…One of the strong points of the study is that it is based on a pragmatic and detailed MR imaging score and comprehensive data on possible confounders of disability. To our knowledge, other studies correlating MR imaging and symptoms have not included this full spectrum of imaging findings [28,30,31]. Although a graded disc disease diagnosis seems reliable in classifying disc alterations on MR images [1], MR imaging performed with current techniques and criteria does not clearly distinguish symptomatic from incidental findings [1,28].…”

Selective diagnostic nerve root block for the evaluation of radicular pain in the multilevel degenerated cervical spine

“…Not seldom, MRI shows significant degenerative pathology at more than one level, on the same (but often also on the opposite) side from the patients symptoms. Degenerative MRI changes occur in the cervical spine frequently also in persons without symptoms [4,5,17,27]. MRI provides only morphological information and does not tell the clinical significance of the findings.…”

Nontraumatic Cervical Disc Herniation in a 21-Year-Old Patient With No Other Underlying Disease

“…19) Because intervertebral discs containing fragments of the cartilaginous endplate prolapse at the final phase of the disc degenerative process, 19) the pathogenesis of cervical disc herniation can be attributed to degenerative changes of the cervical disc. Although cervical disc degenerative change with aging seems to begin from the teens, 20,27,30) Luschka's joints reduce the axial load to the intervertebral disc. 19) Therefore, slight axial load cannot result in cervical disc herniation in patients with little degenerative disc change, which often occurs with lumbar disc herniation.…”