Basic Aspects in MR Imaging of Degenerative Lumbar Disk Disease

Abstract

Degenerative disease may lead to spinal canal stenosis and long-lasting pain. It is among the leading cause of disability that may affect the ability to work. It has become more common in an increasingly aging population. MRI is the most comprehensive imaging modality and provides detailed morphologic information. A standardized terminology facilitates communication with referring physicians. Yet imaging findings need careful interpretation in conjunction with the results of clinical tests and symptoms to truly help guide therapeutic decision making. This review summarizes aspects of normal anatomy of the intervertebral disk, pathologic mechanisms, terminology, and examples of the imaging spectrum of disk degeneration and herniation.

Keywords

MRI - disk - degenerative - spine

• References

• 1 Luoma K, Riihimäki H, Luukkonen R, Raininko R, Viikari-Juntura E, Lamminen A. Low back pain in relation to lumbar disc degeneration. Spine 2000; 25 (4) 487-492
• 2 Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW. Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am 1990; 72 (3) 403-408
• 3 Iida T, Abumi K, Kotani Y, Kaneda K. Effects of aging and spinal degeneration on mechanical properties of lumbar supraspinous and interspinous ligaments. Spine J 2002; 2 (2) 95-100
• 4 Kirkaldy-Willis WH, Wedge JH, Yong-Hing K, Reilly J. Pathology and pathogenesis of lumbar spondylosis and stenosis. Spine 1978; 3 (4) 319-328
• 5 Urban JP, Roberts S. Degeneration of the intervertebral disc. Arthritis Res Ther 2003; 5 (3) 120-130
• 6 Katz JN. Lumbar disc disorders and low-back pain: socioeconomic factors and consequences. J Bone Joint Surg Am 2006; 88 (2) (Suppl. 02) 21-24
• 7 Milette PC. Classification, diagnostic imaging, and imaging characterization of a lumbar herniated disk. Radiol Clin North Am 2000; 38 (6) 1267-1292
• 8 Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine 2001; 26 (17) 1873-1878
• 9 Modic MT, Ross JS. Lumbar degenerative disk disease. Radiology 2007; 245 (1) 43-61
• 10 Nathan H, Islael J. Osteophytes of the vertebral column: an anatomical study of their development according to age, race, and sex with consideration as to their etiology and significance. J Bone Joint Surg Am 1962; 44 (2) 243-268
• 11 Leone A, Guglielmi G, Cassar-Pullicino VN, Bonomo L. Lumbar intervertebral instability: a review. Radiology 2007; 245 (1) 62-77
• 12 Adams MA, Freeman BJ, Morrison HP, Nelson IW, Dolan P. Mechanical initiation of intervertebral disc degeneration. Spine 2000; 25 (13) 1625-1636
• 13 Hurri H, Karppinen J. Discogenic pain. Pain 2004; 112 (3) 225-228
• 14 Kauppila LI, McAlindon T, Evans S, Wilson PW, Kiel D, Felson DT. Disc degeneration/back pain and calcification of the abdominal aorta. A 25-year follow-up study in Framingham. Spine 1997; 22 (14) 1642-1647 ; discussion 1648–1649
• 15 Battié MC, Videman T, Gibbons LE, Fisher LD, Manninen H, Gill K. 1995 Volvo Award in clinical sciences. Determinants of lumbar disc degeneration. A study relating lifetime exposures and magnetic resonance imaging findings in identical twins. Spine 1995; 20 (24) 2601-2612
• 16 Hestbaek L, Iachine IA, Leboeuf-Yde C, Kyvik KO, Manniche C. Heredity of low back pain in a young population: a classical twin study. Twin Res 2004; 7 (1) 16-26
• 17 Coventry MB. Anatomy of the intervertebral disk. Clin Orthop Relat Res 1969; 67 (67) 9-15
• 18 American Journal of Neuroradiology. Nomenclature and classification of lumbar disc pathology. Recommendations. Available at: www.asnr.org/spine_nomenclature/ . Accessed on April 30, 2014
• 19 Schmorl G. Über Knorpelknötchen an den Wirbelbandscheiben. Fortschr Röntgenstr 1928; 38: 265-279
• 20 Pfirrmann CW, Resnick D. Schmorl nodes of the thoracic and lumbar spine: radiographic-pathologic study of prevalence, characterization, and correlation with degenerative changes of 1,650 spinal levels in 100 cadavers. Radiology 2001; 219 (2) 368-374
• 21 Knutsson F. The vacuum phenomenon in the intervertebral discs. Acta Radiol 1942; 23: 173-179
• 22 Grenier N, Grossman RI, Schiebler ML, Yeager BA, Goldberg HI, Kressel HY. Degenerative lumbar disk disease: pitfalls and usefulness of MR imaging in detection of vacuum phenomenon. Radiology 1987; 164 (3) 861-865
• 23 Bielecki DK, Sartoris D, Resnick D, Van Lom K, Fierer J, Haghighi P. Intraosseous and intradiscal gas in association with spinal infection: report of three cases. AJR Am J Roentgenol 1986; 147 (1) 83-86
• 24 Bangert BA, Modic MT, Ross JS , et al. Hyperintense disks on T1-weighted MR images: correlation with calcification. Radiology 1995; 195 (2) 437-443
• 25 Boyko OB, Burger PC, Shelburne JD, Ingram P. Non-heme mechanisms for T1 shortening: pathologic, CT, and MR elucidation. AJNR Am J Neuroradiol 1992; 13 (5) 1439-1445
• 26 Henkelman RM, Watts JF, Kucharczyk W. High signal intensity in MR images of calcified brain tissue. Radiology 1991; 179 (1) 199-206
• 27 Dihlmann W, Stäbler A. Gelenke – Wirbelverbindungen. 4th ed. Stuttgart, Germany: Thieme; 2011
• 28 Modic MT, Steinberg PM, Ross JS, Masaryk TJ, Carter JR. Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology 1988; 166 (1 Pt 1) 193-199
• 29 Ross JS, Robertson JT, Frederickson RC , et al; ADCON-L European Study Group. Association between peridural scar and recurrent radicular pain after lumbar discectomy: magnetic resonance evaluation. Neurosurgery 1996; 38 (4) 855-861 ; discussion 861–863
• 30 Ross JS, Obuchowski N, Zepp R. The postoperative lumbar spine: evaluation of epidural scar over a 1-year period. AJNR Am J Neuroradiol 1998; 19 (1) 183-186
• 31 Masaryk TJ, Boumphrey F, Modic MT, Tamborrello C, Ross JS, Brown MD. Effects of chemonucleolysis demonstrated by MR imaging. J Comput Assist Tomogr 1986; 10 (6) 917-923
• 32 Carrino JA, Lurie JD, Tosteson AN , et al. Lumbar spine: reliability of MR imaging findings. Radiology 2009; 250 (1) 161-170
• 33 Lotz JC, Haughton V, Boden SD , et al. New treatments and imaging strategies in degenerative disease of the intervertebral disks. Radiology 2012; 264 (1) 6-19