Nakashima H, Yukawa Y, Suda K, et al
. Spine. 15 March 2015; 40(6): 392-398.
MR images of cervical spine were analyzed for the anteroposterior spinal cord diameter, disc bulging diameter, and axial cross-sectional area of the spinal cord in 1211 healthy volunteers aged from 20 to 79 years. Result showed majority had disc bulging (87.6%) which increased with age in frequency, severity, and number of levels (Disc bulging was defined as the intervertebral disc protruding posteriorly by more than 1 mm). Even subjects in their 20s had bulging discs with 73.3% and 78.0% of males and females. A few subjects had spinal cord compression SCC (5.3%) and increased cord signal intensity (2.3%); these numbers increased with age, particularly after age 50 years. SCC mainly involved 1 level (58%) or 2 levels (38%), and predominantly occurred at C5–C6 (41%) and C6–C7 (27%).
This study is the largest prospective evaluation of cervical spine MRI in asymptomatic subjects. It shows the prevalence and distribution of abnormalities on MRI of cervical spine in asymptomatic individuals. Disc bulging was noted in a significant majority of subjects, including those in their 20s, with the prevalence and severity increasing with age. The frequency of SCC and increased cord signal intensity increased after age 50 years. The results in this study alerts us to the fact that interventional decisions made only by judging degenerative changes on MRI alone can be mistake-ridden and dangerous, and that clinical decision should be prudent, correlating MRI findings with clinical signs and symptoms.
Image Credit: Grant Fisher, The Noun Project