Short term progression of lumbar disc degeneration cannot be predicted only based on spine intrinsic phenotypes in MRI and X-ray imaging

Introduction: Predicting lumbar disc degeneration is essential for identifying patients who might benefit from future regenerative treatment. Different lumbar phenotypes impact the biomechanical properties and may lead to progressive degeneration of the spine. In this study we investigated, the reliability of X-rays and MRIs in predicting the progression of intervertebral disc degeneration (IVDD)?

Methods: A retrospective longitudinal cohort study was conducted to identify important variables for the progression of intervertebral disc degeneration (IVDD). The study included n = 279 patients (n = 1395 discs), who respectively underwent two lumbar magnetic resonance imaging (MRI) exams with an interval between 1 and 4 years. The Pfirrmann grade was allocated to score IVDD, and the impact of 20 variables in X-ray and MRI was examined. The study used correlation analysis and conditional logistic regression analysis to identify significant variables.

Results: We found no significant correlation between the time interval, which ranged from 1 to 4 years, and the progression of IVDD (rs = .040, p = .134, n = 1395). However, our logistic regression analysis model revealed that certain factors such as female gender (72%), age (2.7%), sacral slope (40%), lower IVD level (45%), osteophytes (37%), end plate defect (100%), protrusion (88%), and Pfirrmann Grade -(48.6%) had significant regression coefficients, indicating their notable impact on IVDD progression. We incorporated these factors into a scoring system for predicting IVDD progression, which resulted in an area under the curve (AUC) of 0.649 (95% Confidence Interval (CI): .596-.702), suggesting poor predictive accuracy.

Conclusion: Lumbar phenotypes like sacral slope, disc level, osteophytes, end plate defect, and protrusion were the most predictive phenotypes for IVDD progression. Relying solely on lumbar phenotypes may not provide, however, enough specificity and sensitivity for predicting IVDD progression.

I have nothing to declare.