Systematic literature review of imaging features of spinal degeneration in asymptomatic populations

W. Brinjikji, P. H. Luetmer, B. Comstock, B. W. Bresnahan, L. E. Chen, Richard (Rick) Deyo, S. Halabi, J. A. Turner, A. L. Avins, K. James, J. T. Wald, D. F. Kallmes, J. G. Jarvik

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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.

Original languageEnglish (US)
Pages (from-to)811-816
Number of pages6
JournalAmerican Journal of Neuroradiology
Volume36
Issue number4
DOIs
StatePublished - Apr 1 2015

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Population
Spine
Literature
Intervertebral Disc Degeneration
Manuscripts
Back Pain
Cluster Analysis
Pain

ASJC Scopus subject areas

  • Clinical Neurology
  • Radiology Nuclear Medicine and imaging

Cite this

Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. R., ... Jarvik, J. G. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology, 36(4), 811-816. https://doi.org/10.3174/ajnr.A4173

Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. / Brinjikji, W.; Luetmer, P. H.; Comstock, B.; Bresnahan, B. W.; Chen, L. E.; Deyo, Richard (Rick); Halabi, S.; Turner, J. A.; Avins, A. L.; James, K.; Wald, J. T.; Kallmes, D. F.; Jarvik, J. G.

In: American Journal of Neuroradiology, Vol. 36, No. 4, 01.04.2015, p. 811-816.

Research output: Contribution to journalArticle

Brinjikji, W, Luetmer, PH, Comstock, B, Bresnahan, BW, Chen, LE, Deyo, RR, Halabi, S, Turner, JA, Avins, AL, James, K, Wald, JT, Kallmes, DF & Jarvik, JG 2015, 'Systematic literature review of imaging features of spinal degeneration in asymptomatic populations', American Journal of Neuroradiology, vol. 36, no. 4, pp. 811-816. https://doi.org/10.3174/ajnr.A4173
Brinjikji, W. ; Luetmer, P. H. ; Comstock, B. ; Bresnahan, B. W. ; Chen, L. E. ; Deyo, Richard (Rick) ; Halabi, S. ; Turner, J. A. ; Avins, A. L. ; James, K. ; Wald, J. T. ; Kallmes, D. F. ; Jarvik, J. G. / Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. In: American Journal of Neuroradiology. 2015 ; Vol. 36, No. 4. pp. 811-816.
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AU - Avins, A. L.

AU - James, K.

AU - Wald, J. T.

AU - Kallmes, D. F.

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N2 - 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.

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