Cross-sectional imaging study associates cervical disc degeneration with older age

The prevalence of cervical disc degeneration in middle-aged patients often follows natural patterns seen on MRI, researchers said.

The degeneration of cervical discs commonly follows a contiguous pattern, rather than a pattern of skipped level disc degeneration, based on results of a recently presented cross-sectional imaging study.

“Disc degeneration is most common in the middle cervical spine and most commonly progresses from that level to the contiguous level, except for C2-3 and C7-T1. This pattern may play a role in adjacent level disc degeneration associated with spinal fusion,” Akinobu Suzuki, MD, PhD, said during his presentation at the American Academy of Orthopaedic Surgeons Annual Meeting.

The study Suzuki and colleagues conducted included 1,059 patients with a mean age of 48.1 years. There were 566 women 493 men in the study. All the patients underwent upright cervical MRI for symptoms of neck pain, with or without neurological symptoms. Patients who reported previous trauma or surgery to the spine were excluded.

Akinobu Suzuki

Grades of disc degeneration

In all 6,354 cervical discs from C2-3 to C7-T1 were evaluated for the study and assigned grades from level 0 to III for cervical disc degeneration (CDD), where grade 0 is no disc degeneration, grade I is mild degeneration with decreased nucleus intensity, grade II is moderate degeneration with a positive disc bulge and grade III is severe degeneration associated with a decrease in disc height.

A grade greater than grade II was considered positive for CDD, according to Suzuki, who is from Osaka, Japan.

“The total grade of cervical disc degeneration significantly correlated with age,” Suzuki said. “The number of degenerated disc levels increased with age. In this study population, none of the patients in their teens had degenerated levels more than grade II, whereas older patients in their 70s had CDD in more than one level,” he said.

One-level two-level degeneration

Degeneration is directly proportional to age, Suzuki noted, saying it is most likely to be contiguous from level to level. Severe disc degeneration is most likely to be found in the middle of the cervical spine, he said, at C5-6, and it typically progresses from that level to contiguous levels, and C7-T1 and C2-3 were the levels most unlikely to degenerate.

In 51.2% of patients with one-level degeneration, C5-6 was the degenerated level, and in 19.8% of patients with one-level degeneration, C4-5 was the degenerated level of note.

In the group with two-level degeneration, C5-6 and C6-7 was the most commonly degenerated levels (40.7%) and the next most commonly degenerated level in these patients was C4-C5 and C5-C6 (27.6%), according to results of the study. – by Robert Linnehan

Reference:

Suzuki A. Paper #224. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 11-15, 2014; New Orleans.

For more information:

Akinobu Suzuki, MD, PhD, can be reached at the Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8585, Japan; email: a-suzuki@msic.med.osaka-cu.ac.jp.
Disclosure: Suzuki has no relevant financial disclosures.