Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations

Abstract

BACKGROUND AND PURPOSE Degenerative changes are commonly found in spine imaging but often occur in pain-free individuals as well as those with back pain. We sought to estimate the prevalence, by age, of common degenerative spine conditions by performing a systematic review studying the prevalence of spine degeneration on imaging in asymptomatic individuals. MATERIALS AND METHODS We performed a systematic review of articles reporting the prevalence of imaging findings (CT or MR imaging) in asymptomatic individuals from published English literature through April 2014. Two reviewers evaluated each manuscript. We selected age groupings by decade (20, 30, 40, 50, 60, 70, 80 years), determining age-specific prevalence estimates. For each imaging finding, we fit a generalized linear mixed-effects model for the age-specific prevalence estimate clustering in the study, adjusting for the midpoint of the reported age interval. RESULTS Thirty-three articles reporting imaging findings for 3110 asymptomatic individuals met our study inclusion criteria. The prevalence of disk degeneration in asymptomatic individuals increased from 37% of 20-year-old individuals to 96% of 80-year-old individuals. Disk bulge prevalence increased from 30% of those 20 years of age to 84% of those 80 years of age. Disk protrusion prevalence increased from 29% of those 20 years of age to 43% of those 80 years of age. The prevalence of annular fissure increased from 19% of those 20 years of age to 29% of those 80 years of age. CONCLUSIONS Imaging findings of spine degeneration are present in high proportions of asymptomatic individuals, increasing with age. Many imaging-based degenerative features are likely part of normal aging and unassociated with pain. These imaging findings must be interpreted in the context of the patient’s clinical condition.

Facet joint injections for people with persistent non-specific low back pain (Facet Injection Study): a feasibility study for a randomised controlled trial

“…A systematic review estimated the prevalence of facet joint degeneration increased from 4% for those in their twenties through 32% for those in their fifties to 83% for those in their eighties. 27 There is not, however, an association observed between radiological change in facet joints and the presence of back pain. 28 If pain arising from the facet joint is suspected clinically, it may be abolished temporarily by the injection of local anaesthetic, which may be used as a diagnostic test.…”

ISSLS PRIZE IN BIOENGINEERING SCIENCE 2017: Automation of reading of radiological features from magnetic resonance images (MRIs) of the lumbar spine without human intervention is comparable with an expert radiologist

“…Although around 85% of cases have no clear diagnoses [2,3], many studies indicate that degeneration of the intervertebral disc is involved [4,5]. MRI classifications of features of disc degeneration have become a major diagnostic tool, even though many with disc degeneration features are asymptomatic [6].…”

Age- and Level-Dependence of Fatty Infiltration in Lumbar Paravertebral Muscles of Healthy Volunteers

“…13,16 One explanation for discrepant findings is the influence of age on muscle composition. 17,18,[27][28][29] Spinal degeneration is known to occur early and increasingly throughout the life span, 30 yet to our knowledge, no study has assessed age-related morphologic changes to lumbar paravertebral muscles in healthy volunteers, which would provide a crucial supplement for future comparative studies. We sought to quantify lumbar paravertebral muscle volume and fat content by 2-point Dixon MR imaging in healthy adult volunteers spanning 4 decades of life, and we aimed to establish an age-and level-dependent reference of lumbar paravertebral muscle volume and fat content as a reflection of natural aging history.…”