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Degenerative Disc Disease of the Spine: Anatomic and Imaging Considerations

  • Michael T. Modic
  • Christian W. A. Pfirrmann
Conference paper

Abstract

Traditionally, disc degeneration has been linked to mechanical loading. The importance of mechanical factors has been emphasized by experiments on cadaver spines with both severe single-event and relentless loading [1–5]. Disc failure is more common in areas where there are the heaviest mechanical stresses, such as the lower lumbar region. It has been suggested that mechanical factors produce endplate damage, the antecedent to disc degeneration [6]. The disc is metabolically active, and the metabolism is dependent on diffusion of fluid either from the marrow of the vertebral bodies across the subchondral bone, the cartilaginous endplate, or through the annulus fibrosus from the surrounding blood vessels. Morphologic changes in vertebral bone and cartilaginous endplate, which occur with advancing age or degeneration, can interfere with normal disc nutrition and further the degenerative process. This disruption of the normal endplate results in deformation when under loading. Compressive damage to the vertebral body endplate alters the distribution of stresses in the adjacent disc.

Keywords

Vertebral Body Intervertebral Disc Nucleus Pulposus Disc Herniation Disc Degeneration 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Adams MA, Hutton WC (1985) Gradual disc prolapse. Spine 10:524–531PubMedCrossRefGoogle Scholar
  2. 2.
    Adams MA, Hutton WC (1982) Prolapsed intervertebral disc. A hyperflexion injury. 1981 Volvo Award in Basic Science. Spine 7:184–191PubMedCrossRefGoogle Scholar
  3. 3.
    Gordon SJ, Yang KH, Mayer PJ et al (1991) Mechanism of disc rupture. A preliminary report. Spine 16:450–456PubMedCrossRefGoogle Scholar
  4. 4.
    McNally DS, Adams MA, Goodship AE (1993) Can intervertebral disc prolapse be predicted by disc mechanics? Spine 18:1525–1530PubMedGoogle Scholar
  5. 5.
    Shirazi-Adl A (1989) Strain in fibers of a lumbar disc. Analysis of the role of lifting in producing disc prolapse. Spine 14:96–103PubMedCrossRefGoogle Scholar
  6. 6.
    Adams MA, Freeman BJ, Morrison HP et al (2000) Mechanical initiation of intervertebral disc degeneration. Spine 25:1625–1636PubMedCrossRefGoogle Scholar
  7. 7.
    Kauppila LI, McAlindon T, Evans S et al (1997) Disc degeneration/back pain and calcification of the abdominal aorta. A 25-year follow-up study in Framingham. Spine 22: 1642–1647PubMedCrossRefGoogle Scholar
  8. 8.
    Kresina TF, Malemud CJ, Moskowitz RW (1986) Analysis of osteoarthritic cartilage using monoclonal antibodies reactive with rabbit proteoglycan. Arthritis Rheum 29:863–871PubMedCrossRefGoogle Scholar
  9. 9.
    Nelson CL, Janecki CJ, Gildenberg PL, Sava G (1972) Disk protrusions in the young. Clin Orthop Relat Res 88:142–150PubMedCrossRefGoogle Scholar
  10. 10.
    Varlotta GP, Brown MD, Kelsey JL, Golden AL (1991) Familial predisposition for herniation of a lumbar disc in patients who are less than twenty-one years old. J Bone Joint Surg Am 73:124–128PubMedGoogle Scholar
  11. 11.
    Matsui H, Terahata N, Tsuji H et al (1992) Familial predisposition and clustering for juvenile lumbar disc herniation. Spine 17:1323–1328PubMedCrossRefGoogle Scholar
  12. 12.
    Scapinelli R (1993) Lumbar disc herniation in eight siblings with a positive family history for disc disease. Acta Orthop Belg 59:371–376PubMedGoogle Scholar
  13. 13.
    Quinet RJ, Hadler NM (1979) Diagnosis and treatment of backache. Semin Arthritis Rheum 8:261–287PubMedCrossRefGoogle Scholar
  14. 14.
    Bonneville JF, Dietemann JL (1992) Imaging in sciatica. Rev Prat 42:554–566PubMedGoogle Scholar
  15. 15.
    Brant-Zawadzki MN, Jensen MC, Obuchowski N et al (1995) Interobserver and intraobserver variability in interpretation of lumbar disc abnormalities. A comparison of two nomenclatures. Spine 20:1257–1263PubMedCrossRefGoogle Scholar
  16. 16.
    Breton G (1991) Is that a bulging disk, a small herniation or a moderate protrusion? Can Assoc Radiol J 42:318PubMedGoogle Scholar
  17. 17.
    Fardon DF, Balderston RA, Garfin SR et al (1991) Disorders of the spine: a coding system for diagnoses. Hanley and Belfus, Philadelphia pp 20–22Google Scholar
  18. 18.
    Milette PC (2001) Reporting lumbar disk abnormalities: at last, consensus! AJNR Am J Neuroradiol 22:428–429PubMedGoogle Scholar
  19. 19.
    Adams P, Eyre DR, Muir H (1997) Biochemical aspects of development and ageing of human lumbar intervertebral discs. Rheumatol Rehabil 16:22–29CrossRefGoogle Scholar
  20. 20.
    Brown MD (1971) The pathophysiology of disc disease. Orthop Clin North Am 2:359–370PubMedGoogle Scholar
  21. 21.
    Lipson SJ, Muir H (1981) Experimental intervertebral disc degeneration: morphologic and proteoglycan changes over time. Arthritis Rheum 24:12–21PubMedCrossRefGoogle Scholar
  22. 22.
    Pfirrmann CW, Metzdorf A, Zanetti M (2001) Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine 26:1873–1878PubMedCrossRefGoogle Scholar
  23. 23.
    de Roos A, Kressel H, Spritzer C, Dalinka M (1987) MR imaging of marrow changes adjacent to end plates in degenerative lumbar disk disease. AJR Am J Roentgenol 149:531–534PubMedCrossRefGoogle Scholar
  24. 24.
    Masaryk TJ, Boumphrey F, Modic MT et al (1986) Effects of chemonucleolysis demonstrated by MR imaging. J Comput Assist Tomogr 10:917–923PubMedCrossRefGoogle Scholar
  25. 25.
    Modic MT, Steinberg PM, Ross JS et al (1988) Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology 166:193–199PubMedGoogle Scholar
  26. 26.
    Ross JS, Robertson JT, Frederickson RC et al (1996) Association between peridural scar and recurrent radicular pain after lumbar discectomy: magnetic resonance evaluation. ADCON-L European Study Group. Neurosurgery 38:855–861PubMedCrossRefGoogle Scholar
  27. 27.
    Ross JS, Obuchowski N, Zepp R (1998) The postoperative lumbar spine: evaluation of epidural scar over a 1-year period. AJNR Am J Neuroradiol 19:183–186PubMedGoogle Scholar
  28. 28.
    Masaryk TJ, Boumphrey F, Modic MT (1986) Effects of chemonucleolysis demonstrated by MR imaging. J Comput Assist Tomogr 10:917–923PubMedCrossRefGoogle Scholar
  29. 29.
    Modic MT, Steinberg PM, Ross JS et al (1988) Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology 166(1 Pt 1):193–199PubMedGoogle Scholar
  30. 30.
    Rahme R, Moussa R (2008) The Modic vertebral endplate and marrow changes: pathologic significance and relation to low back pain and segmental instability of the lumbar spine. AJNR Am J Neuroradiol 29:838–842PubMedCrossRefGoogle Scholar
  31. 31.
    Mitra D, Cassar-Pullicino VN, McCall IW (2004) Longitudinal study of vertebral type-1 end-plate changes on MR of the lumbar spine. Eur Radiol 14:1574–1581PubMedCrossRefGoogle Scholar
  32. 32.
    Modic MT (2007) Modic type 1 and type 2 changes. J Neurosurg Spine 6:150–161PubMedCrossRefGoogle Scholar
  33. 33.
    Vital JM, Gille O, Pointillart V et al (2003) Course of Modic 1 six months after lumbar posterior osteosynthesis. Spine 28:715–721PubMedGoogle Scholar
  34. 34.
    Toyone T, Takahashi K, Kitahara H et al (1994) Vertebral bonemarrow changes in degenerative lumbar disc disease: an MRI study of 74 patients with low back pain. J Bone Joint Surg Br 76:757–764PubMedGoogle Scholar
  35. 35.
    Kuisma M, Karppinen J, Niinimaki J et al (2007) Modic changes in endplates of lumbar vertebral bodies: prevalence and association with low back and sciatic pain among middleaged male workers. Spine 32:1116–1122PubMedCrossRefGoogle Scholar
  36. 36.
    Albert HB, Manniche C (2007) Modic changes following lumbar disc herniation. Eur Spine J 16:977–982PubMedCrossRefGoogle Scholar
  37. 37.
    Ross JS, Zepp R, Modic MT (1996) The postoperative lumbar spine: enhanced MR evaluation of the intervertebral disk. AJNR Am J Neuroradiol 17:323–331PubMedGoogle Scholar
  38. 38.
    Masaryk, TJ, Boumphrey F, Modic MT et al (1986) The effects of chemonucleolysis demonstrated by magnetic resonance imaging. J Comput Assist Tomogr 10:917–923PubMedCrossRefGoogle Scholar
  39. 39.
    Lang P, Chafetz N, Genant HK et al (1990) Lumbar spinal fusion: assessment of functional stability with magnetic resonance imaging. Spine 15:581–588PubMedCrossRefGoogle Scholar
  40. 40.
    Buttermann GR, Heithoff KB, Ogilvie JW et al (1997) Vertebral body MRI related to lumbar fusion results. Eur Spine J 6:115–120PubMedCrossRefGoogle Scholar
  41. 41.
    Chataigner H, Onimus M, Polette A (1998) Surgery for degenerative lumbar disc disease: should the black disc be grafted? Rev Chir OrthopReparatrice Appar Mot 84:583–589Google Scholar
  42. 42.
    Esposito P, Pinheiro-Franco JL, Froelich S, Maitrot D (2006) Predictive value of MRI vertebral end-plate signal changes (Modic) on outcome of surgically treated degenerative disc disease: results of a cohort study including 60 patients. Neurochirurgie 52:315–322PubMedCrossRefGoogle Scholar
  43. 43.
    Harris RI, MacNab I (1954) Structural changes in the lumbar intervertebral discs; their relationship to low back pain and sciatica. J Bone Joint Surg Br 36:304–322PubMedGoogle Scholar
  44. 44.
    Schellinger D, Wener L, Ragsdale BD, Patronas NJ (1987) Facet joint disorders and their role in the production of back pain and sciatica. Radiographics 7:923–944PubMedGoogle Scholar
  45. 45.
    Doyle A, Merrilees M (2004) Synovial cysts of the lumbar facet joints in a symptomatic population: prevalence on magnetic resonance imaging. Spine 29:874–878PubMedCrossRefGoogle Scholar
  46. 46.
    Arnoldi CC, Brodsky AE, Cauchoix J et al (1975) Lumbar spinal stenosis and nerve root entrapment syndromes. Definition and classification. Clin Orthop Relat Res 4–5Google Scholar
  47. 47.
    Deyo RA (1993) Practice variations, treatment fads, rising disability. Do we need a new clinical research paradigm? Spine 18:2153–2162PubMedCrossRefGoogle Scholar
  48. 48.
    Borenstein DG, O’Mara JW Jr, Boden SD et al (2001) The value of magnetic resonance imaging of the lumbar spine to predict low-back pain in asymptomatic subjects: a seven-year follow-up study. J Bone Joint Surg Am 83:1306–1311PubMedGoogle Scholar
  49. 49.
    Zelenka M, Schafers M, Sommer C (2005) Intraneural injection of interleukin-1 beta and tumor necrosis factor-alpha into rat sciatic nerve at physiological doses induces signs of neuropathic pain. Pain 116:257–263PubMedCrossRefGoogle Scholar
  50. 50.
    Sox H, Stern S, Owens D, Abrams HL (1989) Assessment of diagnostic technology in health care. Rationale, methods, problems and directions. National Academy Press, Washington, DCGoogle Scholar
  51. 51.
    Wiesel SW, Tsourmas N, Feffer HL et al (1984) A study of computer-assisted tomography. I. The incidence of positive CAT scans in an asymptomatic group of patients. Spine 9:549–551PubMedCrossRefGoogle Scholar
  52. 52.
    Boden SD, Davis DO, Dina TS et al (1990) Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am 72:403–408PubMedGoogle Scholar
  53. 53.
    Jensen MC, Brant-Zawadzki MN, Obuchowski N et al (1994) Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med 331:69–73PubMedCrossRefGoogle Scholar
  54. 54.
    Saal JA, Saal JS, Herzog RJ (1990) The natural history of lumbar intervertebral disc extrusions treated nonoperatively. Spine 15:683–686PubMedCrossRefGoogle Scholar
  55. 55.
    Modic MT, Ross JS, Obuchowski NA et al (1995) Contrast-enhanced MR imaging in acute lumbar radiculopathy: a pilot study of the natural history. Radiology 195:429–435PubMedGoogle Scholar
  56. 56.
    Modic MT, Obuchowski NA, Ross JS et al (2005) Acute low back pain and radiculopathy. Radiology 237:597–604PubMedCrossRefGoogle Scholar
  57. 57.
    Agency for Healthcare Research and Quality (2001) Treatment of degenerative lumbar spinal stenosis. Summary, evidence report/ technology assessment: no. 32. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/epcsums/stenosum.htmGoogle Scholar
  58. 58.
    Benoist M (2002) The natural history of lumbar degenerative spinal stenosis. Joint Bone Spine 69:450–457PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2012

Authors and Affiliations

  • Michael T. Modic
    • 1
  • Christian W. A. Pfirrmann
    • 2
  1. 1.Neurological InstituteCleveland ClinicClevelandUSA
  2. 2.Radiology, Chefarzt und InstitutsleitungZurichSwitzerland

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