Degenerative disc disease
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Degenerative disc disease is a very common entity in the spine, encountered with increasing frequency throughout life and becoming almost universal in late adulthood to a varying degree. It contributes to billions of dollars in health care costs and lost productivity every year due to associated morbidity.
Degenerative disc disease is regarded as a non-standard term when used as an imaging description as it implies causality between degenerative change and symptoms. The terms "degenerated disc" or "disc degeneration" is preferred 4.
Wide variations exist in the reported prevalence of degenerative changes in the spine, likely related to differences in populations studied and variable definitions of what constitutes degenerative change. Additionally, because degenerative disc disease encompasses such a wide variety of individually defined entities, it is hard to make broad statements about its incidence and related symptomatology.
Vertebral osteophytes, disc height loss, disc signal intensity loss, and disc bulging increase in frequency with age in a nearly linear fashion, but to different degrees, with disc signal loss and vertebral osteophytes increasing the most with age.
Below is a list of conditions that are frequently considered degenerative in nature, and their reported incidence is given in both asymptomatic and symptomatic adult populations 1:
- asymptomatic: ~45% (range 10-81%)
- symptomatic: ~35 % (range 22-48%)
- asymptomatic: ~35% (range 3-63%)
- symptomatic: ~40% (range 0-79%)
- asymptomatic: ~12% (range 0-24%)
- symptomatic: ~30% (range 1-55%)
- asymptomatic: 0%
- reduction in signal intensity of the disc
- asymptomatic: ~50% (range 20-83%)
- symptomatic:~50% (range 9-86%)
- disc height loss
- asymptomatic: ~30% (range 3-56%)
- symptomatic:~35% (range 15-53%)
- annular tears (high-intensity zones)
- asymptomatic: 30% (range 6-56%)
- symptomatic: 15%
- asymptomatic: ~15% (range 8-19%)
- symptomatic: ~45% (range 6-79%)
Degenerative disc disease is related to a combination of biomechanical stresses and genetic predisposition which alter the metabolic and structural integrity of the intervertebral disc. These changes, in turn, modify the ability of the intervertebral disc to sustain and transmit forces, and subsequently, compensate for these alterations (or not) in a variety of ways.
Generally, degenerative changes of the disc affect hydration and elasticity of the cartilaginous endplate, annulus fibrosus and nucleus pulposus, with changes most pronounced in the nucleus pulposus. Within the nucleus pulposus, a loss of water-holding proteoglycans occurs, and within the annulus fibrosus type II collagen increases which reduce disc hydration as well. This makes the disc friable, precipitating fissures and progressive structural degradation. Nitrogen gas may be observed filling these defects as it is pulled from surrounding extracellular fluid, creating the vacuum cleft phenomenon.
- 1. Battié M, Videman T, Parent E. Lumbar Disc Degeneration: Epidemiology and Genetic Influences. Spine (Phila Pa 1976). 2004;29(23):2679-90. doi:10.1097/01.brs.0000146457.83240.eb - Pubmed
- 2. Giuliano V, Giuliano C, Pinto F, Scaglione M. The Use of Flexion and Extension MR in the Evaluation of Cervical Spine Trauma: Initial Experience in 100 Trauma Patients Compared with 100 Normal Subjects. Emerg Radiol. 2002;9(5):249-53. doi:10.1007/s10140-002-0238-3 - Pubmed
- 3. Videman T, Battié M, Gill K, Manninen H, Gibbons L, Fisher L. Magnetic Resonance Imaging Findings and Their Relationships in the Thoracic and Lumbar Spine. Insights into the Etiopathogenesis of Spinal Degeneration. Spine (Phila Pa 1976). 1995;20(8):928-35. doi:10.1097/00007632-199504150-00009 - Pubmed
- 4. Fardon D, Williams A, Dohring E, Murtagh F, Gabriel Rothman S, Sze G. Lumbar Disc Nomenclature: Version 2.0: Recommendations of the Combined Task Forces of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology. Spine J. 2014;14(11):2525-45. doi:10.1016/j.spinee.2014.04.022 - Pubmed