title: Qualitative grading of disc degeneration by magnetic resonance in the lumbar and cervical spine: lack of correlation with histology in surgical cases.
abstract: BACKGROUND
  Clinically, magnetic resonance (MR) imaging is the most effective non-invasive tool for assessing IVD degeneration. Histological examination of the IVD provides a more detailed assessment of the pathological changes at a tissue level. However, very few reports have studied the relationship between these techniques. Identifying a relationship may allow more detailed staging of IVD degeneration, of importance in targeting future regenerative therapies.
  
  
  OBJECTIVE
  To investigate the relationship between MR and histological grading of IVD degeneration in the cervical and lumbar spine in patients undergoing discectomy.
  
  
  METHODS
  Lumbar (N = 99) and cervical (N = 106) IVD samples were obtained from adult patients undergoing discectomy surgery for symptomatic IVD herniation and graded to ascertain a histological grade of degeneration. The pre-operative MR images from these patients were graded for the degree of IVD (MR grade) and vertebral end-plate degeneration (Modic Changes, MC). The relationship between histological and MR grades of degeneration were studied.
  
  
  RESULTS
  In lumbar and cervical IVD the majority of samples (93%) exhibited moderate levels of degeneration (ie MR grades 3-4) on pre-operative MR scans. Histologically, most specimens displayed moderate to severe grades of degeneration in lumbar (99%) and cervical spine (93%). MR grade was weakly correlated with patient age in lumbar and cervical study groups. MR and histological grades of IVD degeneration did not correlate in lumbar or cervical study groups. MC were more common in the lumbar than cervical spine (e.g. 39 versus 20% grade 2 changes; p < 0.05), but failed to correlate with MR or histological grades for degeneration.
  
  
  CONCLUSIONS
  In this surgical series, the resected IVD tissue displayed moderate to severe degeneration, but there is no correlation between MR and histological grades using a qualitative classification system. There remains a need for a quantitative, non-invasive, pre-clinical measure of IVD degeneration that correlates with histological changes seen in the IVD.
authors.affiliation: a Department of Neurosurgery , Greater Manchester Neurosciences Centre (GMNC), Salford Royal NHS Foundation Trust , Manchester , UK ;
authors.forename: B M
authors.initials: BM
authors.lastname: Davies
authors.affiliation: a Department of Neurosurgery , Greater Manchester Neurosciences Centre (GMNC), Salford Royal NHS Foundation Trust , Manchester , UK ;|b Regenerative Medicine , Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Science Centre , Manchester , UK.
authors.forename: R A
authors.initials: RA
authors.lastname: Atkinson
authors.affiliation: b Regenerative Medicine , Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Science Centre , Manchester , UK.
authors.forename: F
authors.initials: F
authors.lastname: Ludwinski
authors.affiliation: b Regenerative Medicine , Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Science Centre , Manchester , UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: Freemont
authors.affiliation: b Regenerative Medicine , Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Science Centre , Manchester , UK.
authors.forename: J A
authors.initials: JA
authors.lastname: Hoyland
authors.affiliation: a Department of Neurosurgery , Greater Manchester Neurosciences Centre (GMNC), Salford Royal NHS Foundation Trust , Manchester , UK ;|b Regenerative Medicine , Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Science Centre , Manchester , UK.
authors.forename: K K
authors.initials: KK
authors.lastname: Gnanalingham
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000473:pathology*; D017586:Diskectomy / Q000379:methods; D005260:Female; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000175:diagnosis* / Q000473:pathology*; D007405:Intervertebral Disc Displacement / Q000175:diagnosis / Q000473:pathology; D008159:Lumbar Vertebrae / Q000473:pathology*; D008161:Lumbosacral Region / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D055815:Young Adult
keywords: Cervical; histology; intervertebral disc; lumbar; magnetic resonance imaging; spine