CLINICAL-RADIOGRAPHIC CORRELATION OF DEGENERATIVE CHANGES OF THE SPINE - SYSTEMATIC REVIEW

Vialle, Emiliano Neves; Vialle, Luiz Roberto Gomes; Simões, Christiano Esteves; Menegaz, Phelipe de Souza

doi:10.1590/S1808-185120161504157006

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Review Article • Coluna/Columna 15 (4) • Oct-Dec 2016 • https://doi.org/10.1590/S1808-185120161504157006 copy

CLINICAL-RADIOGRAPHIC CORRELATION OF DEGENERATIVE CHANGES OF THE SPINE - SYSTEMATIC REVIEW

CORRELAÇÃO CLÍNICO-RADIOLÓGICA DAS ALTERAÇÕES DEGENERATIVAS DA COLUNA - REVISÃO SISTEMÁTICA

CORRELACIÓN CLÍNICO-RADIOLÓGICA DE LOS CAMBIOS DEGENERATIVOS DE LA COLUMNA - REVISIÓN SISTEMÁTICA

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Systematic review of the literature on the evaluation of images of degenerative changes of the spine and its clinical correlation. A systematic literature review was conducted, and the results evaluated for the presence of clinical correlation, as well as the type of imaging method used. The search terms were "Intervertebral Disc Degeneration", "Intervertebral disc", "Classification", "Anulus fibrosus", "Nucleus pulposus", "Lumbar spine", "Degenerative disc disease", "Degeneration", "Zygapophyseal Joint". We also assessed whether there were inter- and intraobserver agreement in the selected works and possible guidelines regarding the treatment and prognosis of patients. Of the 91 reviewed abstracts, 31 articles were selected that met the inclusion criteria. Six articles were related to the cervical spine, 13 to the lumbar spine and 12 were about changes not related specifically to a single segment of the spine. Articles that determined limiting values considered normal were also included, since variations were considered signs of degeneration or pathology. It was not possible to establish the relationship between the changes identified in imaging and the clinical history of patients, either define treatment and prognosis guidelines.

Keywords:
Intervertebral disc degeneration; Intervertebral disc; Classification; Spine; Zygapophyseal joint.

Author	Parameters evaluated	Evaluation method	Clinical correlation
^{Czervionke, 1988}23. Czervionke LF, Daniels DL, Ho PS, Yu SW, Pech P, Strandt J, et al. Cervical neural foramina: correlative anatomic and MR imaging study. Radiology. 1988;169(3):753-9. ²³	Diameter of the cervical foramen	MRI	Yes
^{Uchida, 2009}24. Uchida K, Nakajima H, Sato R, Yayama T, Mwaka ES, Kobayashi S, Baba H. Cervical spondylotic myelopathy associated with kyphosis or sagittal sigmoid alignment: outcome after anterior or posterior decompression. J Neurosurg Spine. 2009;11(5):521-8. ²⁴	Cervical kyphosis and segmental instability associated with myelopathy	X-RAY	Yes
^{Dvorak, 1992}25. Dvorak J, Antinnes JA, Panjabi M, Loustalot D, Bonomo M. Age and gender related normal motion of the cervical spine. Spine (Phila Pa 1976). 1992;17(Suppl 10):S393-8. ²⁵	Amplitude of cervical movement	X-RAY	Yes
^{Pavlov, 1987}26. Pavlov H, Torg JS, Robie B, Jahre C. Cervical spinal stenosis: determination with vertebral body ratio method. Radiology. 1987;164(3):771-5. ²⁶	Diameter of vertebral canal	X-RAY	Yes

Author	Parameters evaluated	Evaluation method	Clinical correlation
^{Lafage, 2009}27. Lafage V, Schwab F, Patel A, Hawkinson N, Farcy JP. Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine (Phila Pa 1976). 2009;34(17):E599-606. ²⁷	Inclinations of the pelvis and trunk (in deformities)	X-RAY	Yes
^{Lazennec, 2000}28. Lazennec JY, Ramaré S, Arafati N, Laudet CG, Gorin M, Roger B, et al. Sagittal alignment in lumbosacral fusion: relations between radiological parameters and pain. Eur Spine J. 2000;9(1):47-55. ²⁸	Sagittal alignment	X-RAY	Yes
^{Yoshimoto, 2005}29. Yoshimoto H, Sato S, Masuda T, Kanno T, Shundo M, Hyakumachi T, et al.Spinopelvic alignment in patients with osteoarthrosis of the hip: a radiographic comparison to patients with low back pain. Spine (Phila Pa 1976). 2005;30(14):1650-7. ²⁹	Sagittal alignment	X-RAY	Yes

Author	Parameters evaluated	Evaluation method	Clinical correlation
^{Wilke, 2006}21. Wilke HJ, Rohlmann F, Neidlinger-Wilke C, Werner K, Claes L, Kettler A. Validity and interobserver agreement of a new radiographic grading system for intervertebral disc degeneration: Part I. Lumbar spine. Eur Spine J. 2006;15(6):720-30. ²¹	Lumbar disc degeneration	X-RAY	NT
^{Kellgren, 1963}31. Kellgren JH, Lawrence JS, editors. The epidemiology of chronic rheumatism: atlas of standard radiographs of arthritis. Oxford: Blackwell Scientific; 1963. ³¹	Cervical disc degeneration	X-RAY	NT
^{Cote, 1997}32. Côté P, Cassidy JD, Yong-Hing K, Sibley J, Loewy J. Apophysial joint degeneration, disc degeneration, and sagittal curve of the cervical spine. Can they be measured reliably on radiographs? Spine (Phila Pa 1976). 1997;22(8):859-64. ³²	Facet and disc degeneration and cervical sagittal curvature	X-RAY	NT
^{Mimura, 1994}33. Mimura M, Panjabi MM, Oxland TR, Crisco JJ, Yamamoto I, Vasavada A. Disc degeneration affects the multidirectional flexibility of the lumbar spine. Spine (Phila Pa 1976). 1994;19(12):1371-80. ³³	Lumbar disc degeneration	X-RAY	NT
^{Lane, 1993}34. Lane NE, Nevitt MC, Genant HK, Hochberg MC. Reliability of new indices of radiographic osteoarthritis of the hand and hip and lumbar disc degeneration. J Rheumatol. 1993;20(11):1911-8. ³⁴	Lumbar disc degeneration	X-RAY	NT
Kettle, 2006³⁵	Cervical disc degeneration	X-RAY	NT

Author	Parameters evaluated	Evaluation method	Clinical correlation
^{Pathria, 1987}36. Pathria M, Sartoris DJ, Resnick D. Osteoarthritis of the facet joints: accuracy of oblique radiographic assessment. Radiology. 1987;164(1):227-30. ³⁶	Facet degeneration	X-RAY and CT	NT
^{Weishaupt, 1999}37. Weishaupt D, Zanetti M, Boos N, Hodler J. MR imaging and CT in osteoarthritis of the lumbar facet joints. Skeletal Radiol. 1999;28(4):215-9. ³⁷	Facet degeneration	CT and MRI	NT
^{Stadnik, 1998}38. Stadnik TW, Lee RR, Coen HL, Neirynck EC, Buisseret TS, Osteaux MJ. Annular tears and disk herniation: prevalence and contrast enhancement on MR images in the absence of low back pain or sciatica. Radiology. 1998;206(1):49-55. ³⁸	Annular lesion and disc herniation	MRI	Weak
^{Modic, 1988}39. 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):193-9. ³⁹	Change in the vertebral plateau	MRI	Weak
^{Pfirrmann, 2004}40. Pfirrmann CW, Dora C, Schmid MR, Zanetti M, Hodler J, Boos N. MR image-based grading of lumbar nerve root compromise due to disk herniation: reliability study with surgical correlation. Radiology. 2004;230(2):583-8. ⁴⁰	Morphology of the intervertebral disc	MRI	NT
^{Miyazaki, 2008}41. Miyazaki M, Hong SW, Yoon SH, Morishita Y, Wang JC. Reliability of a magnetic resonance imaging-based grading system for cervical intervertebral disc degeneration. J Spinal Disord Tech. 2008;21(4):288-92. ⁴¹	Cervical intervertebral disc	MRI	NT
^{Adams, 1986}19. Adams MA, Dolan P, Hutton WC. The stages of disc degeneration as revealed by discograms. J Bone Joint Surg Br. 1986;68(1):36-41. ¹⁹	Disc degeneration	Discography	Weak

Changes evaluated	Author	Method used
Cervical
Osteophytes, disc height, and sclerosis of the vertebral plateau	Kelgren 1963³¹	X-RAY Profile
Osteophytes and changes in the articular apophyses	Kelgren 1963³¹	X-RAY Profile
Loss of height, osteophytic formation, and diffuse sclerosis	^{Wilke 2006}21. Wilke HJ, Rohlmann F, Neidlinger-Wilke C, Werner K, Claes L, Kettler A. Validity and interobserver agreement of a new radiographic grading system for intervertebral disc degeneration: Part I. Lumbar spine. Eur Spine J. 2006;15(6):720-30. ²¹	X-RAY Profile
Intervertebral disc degeneration	^{Miyazaki 2008}41. Miyazaki M, Hong SW, Yoon SH, Morishita Y, Wang JC. Reliability of a magnetic resonance imaging-based grading system for cervical intervertebral disc degeneration. J Spinal Disord Tech. 2008;21(4):288-92. ⁴¹	MRI
Kyphosis and segmental instability associated with myelopathy	^{Uchida 2009}24. Uchida K, Nakajima H, Sato R, Yayama T, Mwaka ES, Kobayashi S, Baba H. Cervical spondylotic myelopathy associated with kyphosis or sagittal sigmoid alignment: outcome after anterior or posterior decompression. J Neurosurg Spine. 2009;11(5):521-8. ²⁴	X-RAY Profile
Lumbar
Lumbar disc degeneration	^{Adams 1986}19. Adams MA, Dolan P, Hutton WC. The stages of disc degeneration as revealed by discograms. J Bone Joint Surg Br. 1986;68(1):36-41. ¹⁹	Discography
Facet degeneration	^{Pathria 1987}36. Pathria M, Sartoris DJ, Resnick D. Osteoarthritis of the facet joints: accuracy of oblique radiographic assessment. Radiology. 1987;164(1):227-30. ³⁶	X-RAY Oblique
Bone marrow changes located in the vertebral body	^{Modic 1988}39. 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):193-9. ⁴²	MRI
Articular narrowing, osteophytes and subchondral sclerosis	^{Lane 1993}34. Lane NE, Nevitt MC, Genant HK, Hochberg MC. Reliability of new indices of radiographic osteoarthritis of the hand and hip and lumbar disc degeneration. J Rheumatol. 1993;20(11):1911-8. ³⁴	X-RAY Profile
Disc height, osteophytes, and subchondral sclerosis	^{Mimura 1994}33. Mimura M, Panjabi MM, Oxland TR, Crisco JJ, Yamamoto I, Vasavada A. Disc degeneration affects the multidirectional flexibility of the lumbar spine. Spine (Phila Pa 1976). 1994;19(12):1371-80. ³³	X-RAY (AP and Profile)
Facet degeneration	^{Weishaupt 1999}37. Weishaupt D, Zanetti M, Boos N, Hodler J. MR imaging and CT in osteoarthritis of the lumbar facet joints. Skeletal Radiol. 1999;28(4):215-9. ³⁷	CT + MRI
Disc degeneration	^{Pfirrmann 2001}49. Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976). 2001;26(17):1873-8. ⁴⁹	MRI
Loss of height, osteophytic formation, and diffuse sclerosis	^{Wilke 2006}21. Wilke HJ, Rohlmann F, Neidlinger-Wilke C, Werner K, Claes L, Kettler A. Validity and interobserver agreement of a new radiographic grading system for intervertebral disc degeneration: Part I. Lumbar spine. Eur Spine J. 2006;15(6):720-30. ²¹	X-RAY (AP and Profile)

Loss of height	Osteophytic formation	Diffuse sclerosis	Total grade of degeneration
Loss of anterior and posterior height respecting the individual height prior to degeneration	Sum of the points of the 2 extremities 0= 0 points <3 mm= 1 point ≤3 and < 6 mm = 2 points ≥6= 3 points	Sum of the points of the adjacent bodies No sclerosis: 0 points 0.25 partially or completely affected: 1 point 0.5 partially or completely affected: 2 points >0.5 partially or completely affected: 3 points	Sum of the points from "Loss of height", "Osteophytic Formation", and "Diffuse Sclerosis".
0= 0%	0=0 points	0= 0 points	0 points = grade 0(without degeneration)
1 < 33%	1= 1-8 points	1= 1-2 points	1-3 points = grade 1 (mild degeneration)
2 ≥33 < 66%	2= 9-16 points	2= 3-4 points	4-6 points = grade 2 (moderate degeneration)
3≥ 66%	3= 17-24 points	3= 5-6 points	7-9 points = grade 3 (severe degeneration).

Narrowing of articular space	Anterior and posterior osteophytes	Sclerosis of the vertebral plateau	Grading of the degeneration
0= None 1= Mild 2= Moderate 3= Severe (total loss)	0= None 1= Small 2= Moderate 3= Large	0= None 1= Present	Grade 0= Normal articulation (0 for osteophytes and narrowing) Grade I= Moderate (1) narrowing or mild (1) osteophytes Grade II = Moderate-Severe (2-3) narrowing and/or moderate to severe (2-3) osteophytes

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[1] Correspondence: Rua Brigadeiro Franco, 979, Curitiba, PR, Brazil. 80430-210. evialle@hotmail.com