Trends and patterns of thoracic intervertebral disc degeneration in symptomatic subjects: a magnetic resonance imaging analysis

Mesregah, Mohamed Kamal; Repajic, Michael; Patel, Kishan; Gardner, Carson; Roberts, Sidney; Buser, Zorica; Wang, Jeffrey

doi:10.1007/s00586-021-06895-0

Cited by 7 publications

(5 citation statements)

References 23 publications

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“…The pattern of degenerative changes in the thoracic spine and utilization of thoracic spine MRI is poorly understood and studied, especially compared to lumbar spine MRI, which has been extensively studied. 7,8,9,10,11 Multiple studies have found that lumbar spine MRI is overutilized and may lead to higher patient risk and increased healthcare costs. 8,12,13 These findings have driven the Center for Medicare and Medicaid Services (CMS) to add these ordering metrics as one of the quality measures in the Hospital Outpatient Quality Reporting Program.…”

Section: Discussionmentioning

confidence: 99%

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Association of Thoracic MRI Findings With Specialty and Training

Linna

Zhang

Farooqi

et al. 2022

Global Spine Journal

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Study Design Retrospective Objective To compare the rate of positive pathology on thoracic MRI ordered by surgical spine specialists to those ordered by nonsurgical spine specialists. Methods Outpatient thoracic MRIs from January–March 2019 were evaluated from a single academic health care system. Studies without a known ordering provider, imaging report, or patients with known presence of malignancy, multiple sclerosis, recent trauma, or surgery were excluded (n = 320). Imaging studies were categorized by type of provider placing the order (resident, attending, or advanced practice practitioner) and department. MRIs were deemed positive if they showed relevant pathology that correlated with indication for exam as determined by a radiologist. One-sided chi-squared analysis was performed to determine statistical significance. Results Overall, our data demonstrated 17.2% of studies with positive pathology. Compared to nonspecialty clinicians, subspecialists showed 35/184 (19.0%) positivity rate versus the non-specialist with 20/136 (14.7%) positivity rate (P = .156). Posthoc analysis demonstrated that surgical specialists who order thoracic MRIs yield significantly higher positivity rates at 19/79 (24.0%) compared to nonsurgical specialists at 36/241 (14.9%) (P < .05). Overall, neurosurgery demonstrated the highest rate of positive thoracic MRIs at 14/40 (35.0%). Comparison between the rate of positivity between physicians and advanced practitioners was insignificant (P > .05). Conclusions Clinical diagnosis of symptomatic thoracic spine degenerative disease requires an expert physical exam combined with careful attention to radiology findings. Although the percent of relevant pathology on thoracic MRI is low, our data suggests evaluation by a surgical specialist should precede ordering a thoracic spine MRI.

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Section: Discussionmentioning

confidence: 99%

“…14 A majority of symptomatic patients that undergo a thoracic spine MRI have mild disc degeneration. 10 Additionally, a reduction in unnecessary imaging studies can reduce healthcare cost.…”

Section: Discussionmentioning

confidence: 99%

Association of Thoracic MRI Findings With Specialty and Training

Linna

Zhang

Farooqi

et al. 2022

Global Spine Journal

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“…Schneiderman grading: 1 = slight decrease in signal intensity in the nucleus pulposus; 2 = generalized hypointense nucleus; 3 = generalized hypointense nucleus with disc space narrowing. Disc hypointensity seen in Pfirrmann grades 4 and 5 was considered as DD 6,7,19. A particular spinal segment (cervical, thoracic, or lumbar) was considered to be degenerated if any disc within the segment has degenerated.…”

Section: Methodsmentioning

confidence: 99%

“…Disc hypointensity seen in Pfirrmann grades 4 and 5 was considered as DD. 6 , 7 , 19 A particular spinal segment (cervical, thoracic, or lumbar) was considered to be degenerated if any disc within the segment has degenerated. A subanalysis of subjects with thoracic DD divided participants into 2 groups, subjects with “isolated thoracic degeneration”—those with any level(s) of DD found exclusively in the thoracic spine, versus “tandem thoracic degeneration”—those with thoracic degeneration and concurrent degeneration in the cervical and/or lumbar segment.…”

Section: Methodsmentioning

confidence: 99%

Why Are Some Intervertebral Discs More Prone to Degeneration?

Cheung

2023

Spine

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Study Design. Prospective observational study. Objective. To determine the prevalence of isolated thoracic degeneration on magnetic resonance imaging (MRI), demographic factors and imaging features, as well as the patient-reported quality of life outcomes associated with this condition. Summary of Background Data. Thoracic intervertebral discs are least susceptible to disc degeneration (DD) and may represent a manifestation of "dysgeneration." These discs may never be hydrated from the beginning and seem hypointense on MRI. Patients and Methods. A population-based MRI study of 2007 volunteers was conducted. Each disc from C2/3 to L5/S1 was measured by Pfirrmann and Schneiderman grading. Disc herniation, Schmorl node (SN), high-intensity zones (HIZ), and Modic changes were studied. DD was defined by Pfirrmann 4 or 5. patient-reported quality of life scores, including a 36-item shortform questionnaire and visual analog scale for low back pain, were recorded. Subjects were divided into "isolated thoracic degeneration" (only thoracic segment) and "tandem thoracic degeneration" (thoracic with other segments). The association between imaging findings and isolated thoracic degeneration was determined using multivariate logistic regression. Results. The mean age of the subjects was 50.0 ± 0.5 and 61.4% were females (n = 1232). Isolated thoracic degeneration was identified in 2.3% of the cohort. Factors associated with isolated thoracic degeneration included lower age, C6/7 HIZ, T8/9 HIZ, and T8/9 SN. Factors associated with tandem thoracic degeneration included L4/5 posterior bulging. The thoracic and lumbar tandem degeneration group demonstrated higher bodily pain, despite a lower visual analog scale, and a higher physical component score of the 36-item short form. Conclusions. Isolated thoracic degeneration demonstrated an earlier age of onset, mostly involving the mid-thoracic region (T5/ 6-T8/9), and in association with findings such as SN. Subjects with tandem thoracolumbar degeneration had less severe lumbar DD and low back pain as compared with those with isolated lumbar degeneration. This paints the picture of "dysgeneration" occurring in the thoracic and lumbar spine.

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“…In 2021, Mesregah et al [42] reported a cross-sectional MRI study of trends and patterns of thoracic intervertebral disc degeneration in symptomatic subjects. In this study, the total grade of IVD degeneration and the number of degenerated levels increased with increasing age.…”

Section: Prevalence Of Thoracic Degenerative Spinal Disease (Table 3)mentioning

confidence: 99%

Prevalence of Cervical and Thoracic Spinal Disease: A Systematic Review

Ju¹,

Kim²,

Kim³

et al. 2023

J Minim Invasive Spine Surg Tech

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Objective: This study aimed to comprehensively assess the prevalence and distribution of degenerative cervical and thoracic diseases with compression of the spinal cord, such as disc herniation (TDH) or hypertrophied ligamentum flavum causing stenosis, by reviewing the literature. Methods: We searched PubMed/MEDLINE to identify articles on the prevalence of degenerative diseases with compression of the spinal cord in the cervical and thoracic spine. The levels of evidence were classified according to the NASS 2005 method. We selected articles containing information on the prevalence of degenerative cervical and thoracic diseases.Results: We identified 358 articles. Thirty-eight met our criteria, with evidence ranging from levels I to V. The prevalence of asymptomatic spinal cord compression lesions was found to be relatively high in elderly people with underlying conditions. Non-traumatic spinal cord injuries are caused by various degenerative diseases involving spinal cord compression, such as cervical myelopathy, ossification of the posterior longitudinal ligament, and ossification of the ligamentum flavum, and are observed in more than 50% of patients with lesions in Japan and the United States, more than 30% in Europe, and more than 20% in Australia. Regarding thoracic lesions, a prevalence of 5% to 10% has been reported for various spinal cord compression lesions such as herniated disc, ossification of the posterior longitudinal ligament, and ossification of the ligamentum flavum.Conclusion: Spinal cord compressive lesions appear not to be rare in the cervical and thoracic spine. The radiographic findings of various stenotic lesions must be well understood and correlated with clinical symptoms before treatment decisions.

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Trends and patterns of thoracic intervertebral disc degeneration in symptomatic subjects: a magnetic resonance imaging analysis

Cited by 7 publications

References 23 publications

Association of Thoracic MRI Findings With Specialty and Training

Association of Thoracic MRI Findings With Specialty and Training

Why Are Some Intervertebral Discs More Prone to Degeneration?

Prevalence of Cervical and Thoracic Spinal Disease: A Systematic Review

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