Disc degeneration of cervical spine on MRI in patients with lumbar disc herniation: comparison study with asymptomatic volunteers

Abstract

An association between progression of cervical disc degeneration and that of lumbar disc degeneration has been considered to exist. To date, however, this association has not yet been adequately studied. Age-related changes in the cervical intervertebral discs were evaluated by magnetic resonance imaging (MRI) in patients with lumbar disc herniation, and compared with the MRI findings of healthy volunteers without lower back pain. The purpose of this study was to clarify whether the prevalence of asymptomatic cervical disc degeneration is higher in patients with lumbar disc herniation than in healthy volunteers. The study was conducted on 51 patients who were diagnosed as having lumbar disc herniation and underwent cervical spine MRI. The patients consisted of 34 males and 17 females ranging in age from 21-83 years (mean 46.9 ± 14.5 years) at the time of the study. The control group was composed of 113 healthy volunteers (70 males and 43 females) aged 24-77 years (mean 48.9 ± 14.7 years), without neck pain or low back pain. The percentage of subjects with degenerative changes in the cervical discs was 98.0% in the lumbar disc herniation group and 88.5% in the control group (p = 0.034). The presence of lumbar disc herniation was associated significantly with decrease in signal intensity of intervertebral disc and posterior disc protrusion in the cervical spine. None of the MRI findings was significantly associated with the gender, smoking, sports activities, or BMI. As compared to healthy volunteers, patients with lumbar disc herniation showed a higher prevalence of decrease in signal intensity of intervertebral disc and posterior disc protrusion on MRI of the cervical spine. The result of this study suggests that disc degeneration appears to be a systemic phenomenon.

Fig. 1

a, b Cervical spine MRI T2-weighted sagittal image: the intervertebral disc a is grade 0 in decrease in signal intensity of intervertebral disc, and grade 0 in disc space narrowing. The intervertebral disc b was : grade 1 in decrease in signal intensity of intervertebral disc and grade 1 in disc space narrowing. c Cervical spine MRI T2-weighted axial image shows grade 0 in posterior disc protrusion. d Cervical spine MRI T2-weighted axial image shows grade 1 in posterior disc protrusion

Fig. 2

A 36-year-old female with lumbar disc herniation at L4–5 on the left side but with no symptom related to the cervical spine. a Lumbar spine MRI T2-weighted sagittal image: disc herniation with protrusion into the spinal canal is observed at L4–5. b Lumbar spine MRI T2-weighted axial image: L4–5 level. Disc herniation is observed on the left side with nerve root compression. c Cervical spine MRI T2-weighted sagittal image: reduced disc intensity visible from C2–3 through C6–7 levels. Posterior disc protrusion noted at C5–6 and C6–7 levels. Disc space narrowing was observed at C5–6 and C6–7 levels. d Cervical spine MRI T2-weighted axial image: C5–6 level. Large disc protrusion is observed