title: Is an annular tear a predictor for accelerated disc degeneration?
abstract: OBJECTIVE
  It is questionable whether an annular tear (AT) is a predictor for accelerated degeneration of the intervertebral discs. The aim of the present study was to answer this question via a matched case-control study design that reliably eliminates potential confounders.
  
  
  METHODS
  Presence or absence of AT, defined as a hyperintense lesion within the annular fibrosus on T2-weighted non-contrast MRI images, was documented in 450 intervertebral lumbar discs of 90 patients who could be followed up for at least 4 years with MRI. Discs with an AT (n = 36) were matched 1:1 to control discs according to the level, degree of initial disc degeneration on MRI (both Pfirrmann grade median 4, range 3-4), age (59.5 ± 15.0 versus 59.3 ± 14.6 years), BMI (26.7 ± 4.4 versus 26.9 ± 4.4 kg/m(2)) and interval to the follow-up MRI (4.8 ± 0.9 versus 5.1 ± 0.8 years). The degree of disc degeneration after a minimum of 4 years was graded on the follow-up MRI in both groups according to the Pfirrmann classification.
  
  
  RESULTS
  One-fourth (25%) of the 36 discs with an AT on the initial MRI exam progressed in degeneration. This was similar to the rate of the matched control discs with no AT, in which also around one-fourth (22%) showed a progression of degeneration (p = 1.00), also without any difference in the degree of degeneration.
  
  
  CONCLUSIONS
  Discs with a Pfirrmann grade >2 with an AT, defined by a hyperintense signal intensity on MRI, are not prone to accelerated degeneration if compared to discs without an AT. Therefore, the presence of an AT per se does not predict accelerated disc degeneration.
authors.affiliation: MRI, Radiology Department, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA, nadja.farshad@yahoo.com.
authors.forename: Nadja A
authors.initials: NA
authors.lastname: Farshad-Amacker
authors.forename: Alexander P
authors.initials: AP
authors.lastname: Hughes
authors.forename: Alexander
authors.initials: A
authors.lastname: Aichmair
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Herzog
authors.forename: Mazda
authors.initials: M
authors.lastname: Farshad
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D015986:Confounding Factors, Epidemiologic; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007403:Intervertebral Disc / Q000473:pathology*; D055959:Intervertebral Disc Degeneration / Q000453:epidemiology / Q000473:pathology*; D008159:Lumbar Vertebrae / Q000473:pathology; D008161:Lumbosacral Region / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index