1. IN-VIVO LONGITUDINAL EVOLUTION OF DEGENERATIVE INTERVERTEBRAL DISC CHANGES ON MR IMAGING IN STRESSED AND NON-STRESSED SEGMENTS OF THE LUMBAR SPINE Pooria Javadi, MD. Swapnil Bagade, MD. Charles Hildebolt, PhD. Samantha Lancaster, MD. Aseem Sharma, MD. ASNR 2015 Electronic Poster # 145

2. Disclosure The authors of this presentation have no financial disclosures.

3. 1. Magnetic resonance imaging (MRI) in the younger population with pars interarticularis and pedicle stress injuries can be used as a model to study the segmental variation in complex mechanical forces affecting the lumbar spine. 2. Previously, higher burden of early degenerative changes involving individual intervertebral disc in stressed segments of spine has been shown 3. The aim of this study is to evaluate temporal evolution of degenerative disc disease in spinal segments experiencing higher mechanical stresses. Purpose

4. Material & Methods A total of 16 consecutive individuals with 17 stressed segments (<25 years old) who had follow-up MR imaging of the lumbar spine for bony stress reaction in posterior spinal elements. Demographics Gender: 6 female and 10 male Mean age: 15.1 (range 5-19) Mean duration of follow up between the two exams: 14.9 months (range 2-47 months)

5. Definitions:  Stressed Discs: Both intervertebral discs adjacent to the stressed bony segments  Control Discs: All non-stressed discs between T12 through S1 segments  Loading Matched Control Discs: Non-stressed discs in the same segment to which the stressed disc belongs. Upper segment: Discs between T12 through L2 Lower segment: Discs between L3 through S1

6. Two board certified radiologists, including one with additional qualification in neuroradiology, evaluated these scans for degenerative changes in individual components of T12 through S1 intervertebral discs, namely annular fissures (AFs), radial fissures (RFs), herniations, nuclear degeneration, endplate defects (EPDs), and Modic type end plate degenerative changes Nuclear degeneration was assessed both on grading system proposed by Pfirrmann et al and a previously described 6-point signal intensity scale

7. Stressed segments versus loading matched nonstressed segments Stressed segments (17 total) 7/17 (41.7%, p 0.007 Fischer exact Results Interval worsening of of at least one degenerative parameter Loading matched nonstressed (16 total) Interval worsening of of at least one degenerative parameter 0/16 2 patients had improved stress reaction without a bony defect

8. 2 (11.8%) new AF Worsening of degenerative parameters in superior stressed segments 3 (17.7%) worsened signal intensity grades (by 1 grade in all) Both new radial tears 1 (5.9%) with worsened degeneration generation on Pfirrman’s classification scheme (by one grade)

9. 1 (5.9%)new AF Worsening of degenerative parameters in inferior stressed segments 4 (23.5%) worsened signal intensity grade (by 1, 2, 3 and 4 grades) 3 (17.7%) worsened Pfirrman’s degeneration grades (by 1,2, & 4 grades) Two (11.8%) new herniation

10. Spinal segments demonstrating imaging evidence for increased bony stresses demonstrate increased likelihood for progressive degeneration of intervertebral discs compared to spinal segments without imaging evidence for increased bony stresses. Conclusion

11. Limitations of the study:  Small numbers of patients  Relatively short follow-up duration  No correlation with clinical symptomatology  Long term effects of such accelerated disc degeneration remain unknown

12. References 1) Sharma A, Parsons M, Pilgram T. Temporal interactions of degenerative changes in individual components of the lumbar intervertebral discs: A sequential magnetic resonance imaging study in patients less than 40 years of age. Spine. 2011;36:1794-1800 2) Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine. 2001;26:1873-1878. 3) Sharma A, Pilgram T, Wippold FJ, 2nd. Association between annular tears and disk degeneration: A longitudinal study. AJNR. American journal ofneuroradiology. 2009;30:500-506.

13. References 4) Sharma A, Lancaster S, Bagade S, Hildebolt C. Early Pattern of Degenerative Changes in Individual Components of Intervertebral Discs in Stressed and Non-Stressed Segments of Lumbar Spine: An In- Vivo MR Imaging Study. Spine. 2014: 39: 1084-90. 5) Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine. 2001; 26:1873-1878