A 20-YEAR PROSPECTIVE LONGITUDINAL STUDY OF DEGENERATION OF THE CERVICAL SPINE IN A VOLUNTEER COHORT ASSESSED USING MRI. FOLLOW-UP OF A CROSS-SECTIONAL STUDY.

Review written by Dr Sandy Hilton info

BACKGROUND & OBJECTIVE

Magnetic resonance imaging (MRI) provides resolution and visualization of the morphological changes that occur in soft tissue and bone including changes in the nucleus and annulus, reductions in disc height, and changes in the subchondral bone. This paper reports on a longitudinal study over a 20-year period, beginning with an original study of 497 healthy participants who had no clinically relevant cervical related symptoms. In the initial study, degenerative changes where found on MRI in 17% males and 12% of females in their 20s, and 86% males and 89% females in their 60s. 10 years later (n=223) MRI found progression of degeneration in 81% of subjects, and 34% had developed clinical symptoms. The author's main aim was to identify the progression of cervical degenerative changes and what clinical symptoms developed over time.

METHODS

193 of the original 497 participants agreed to follow-up at 20yrs. All completed a questionnaire on cervical-related symptoms and daily habits. Symptoms where positive if they were present for 3+ days in the prior month and included: Neck pain, Headache, Stiff Shoulders, Upper Limb Pain, Numbness in the upper limbs (Nausea, Vertigo, and Low Back Pain data was excluded from the study). MRI findings from C2-T1 were collected using a numeric grading scale of 0-4 based on severity to identify:

  1. Decrease in signal intensity of the intervertebral disc
  2. Anterior compression of the dura and spinal cord
  3. Posterior disc protrusion
  4. Disc-space narrowing
  5. Foraminal stenosis

For the purpose of the study, progression of degeneration is defined as at least 1 grade at 1 or more intervertebral levels. The rate of progression was defined as the proportion of subjects whose MRI findings showed progression. 2 radiologists read the MRIs independently and were blinded to the clinical symptom data.

RESULTS

Disc degeneration progressed at 1 or more levels in 95.3% of the subjects. The rates of progression of degeneration among all participants: 81.3% Decrease in signal intensity of the intervertebral disc 86% Anterior compression of the dura and spinal cord

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