Systemic literature review of imaging features of spinal degener

Brinjiji W, Luetmer PH, Comstock B et al. Systemic literature review of imaging features of spinal degeneration in asymptomatic populations. Am J Neuroradiol 2015;36

  • It is important to know the prevalence of imaging findings of degenerative disease in asymptomatic populations.
  • The aim of this study was to systemically review the literature to determine the age-specific prevalence of various imaging findings often associated with degenerative spine disease in asymptomatic individuals.
  • Asymptomatic individuals were defined as those with no history of back pain.
  • Thirty-three studies reporting imaging findings for 3110 individuals met the inclusion criteria for this systemic review.
  • results
  • Disk degeneration prevalence ganged from 37% of asymptomatic individuals 20 years of age to 96% of those 80 years of age, with a large increase in the prevalence through 50 years.
  • Disk signal loss (“black disk”) was similarly present in more than half of individuals older than 40 years of age, and by 60 years, 86% of individuals had disk signal loss.
  • Authors rarely reported face degeneration in younger individuals (4-9% in those 20 and 30 years of age), but the prevalence increased sharply with age.
  • Spondylolisthesis was not commonly found in asymptomatic individuals until 60 years , when prevalence was 23%; prevalence increased substantially at 70 and 80 years
  • discussion
  • Our study suggests that imaging findings of degenerative changes such as disk degeneration, disk signal loss, disk height loss, disk protrusion, and facet arthropathy are generally part of the normal aging process rather than pathologic processes requiring intervention.
  • The results from this systematic review strongly suggest that when degenerative spine findings are incidentally seen (ie, as part of imaging for an indication other than pain or an incidental disk herniation at a level other than where a patient’s pain localizes), these findings should be considered as normal age-related changes rather than pathologic processes.
  • This literature, combined with the results of our study, highlights the importance of caution and of knowledge of the prevalence of imaging findings in similarly aged asymptomatic individuals when interpreting the clinical significance of imaging findings in patients with low back pain.
  • our study supports the hypothesis that degenerative changes observed on CT and MR imaging are often seen with normal aging. The substantial variation in the prevalence of degenerative findings between age groups of asymptomatic individuals highlights the importance of establish further diagnosis criteria to help distinguish age-related degenerative changes from pathologic, pain-generating degenerative changes.
  • conclusion
  • imaging evidence of degenerative spine disease is common in asymptomatic individuals and increased with age. These findings suggest that many imaging-based degenerative features may be part of normal aging and unassociated with low back pain, especially when incidentally seen These imaging findings must be interpreted in the context of the patient’s clinical condition.