Yonsei Med J.  2010 May;51(3):414-420. 10.3349/ymj.2010.51.3.414.

Types and Prevalence of Coexisting Spine Lesions on Whole Spine Sagittal MR Images in Surgical Degenerative Spinal Diseases

• Han IH
• Suh SH
• Kuh SU
• Chin DK
• Kim KS

• KMID: 1074994
• DOI: http://doi.org/10.3349/ymj.2010.51.3.414

Abstract

PURPOSE
We investigated types and prevalence of coexisting lesions found on whole spine sagittal T2-weighted images (WSST2I) acquired from magnetic resonance imaging (MRI) and evaluated their clinical significance in surgical degenerative spinal diseases.
MATERIALS AND METHODS
Coexisting spinal lesions were investigated using WSST2I from 306 consecutive patients with surgical degenerative spinal diseases. Severity of coexisting lesions was classified into four grades (0-3). Lesions of grade 2 and 3 were defined as "meaningful coexisting spine lesions" (MCSL). Degenerative spinal diseases were classified into three pathologies: simple disc herniation, degenerative spinal stenosis, and ligament ossification disease. The relationships between MCSL, gender, age, and primary spine lesions were analyzed.
RESULTS
MCSL were found in 95 patients: a prevalence of 31.1%. Five out of 95 MCSL were surgically managed. The most common types of MCSL were disc herniation with 13.1% prevalence, followed by degenerative stenosis (9.5%) and ligament ossification diseases (6.8%). Older patients (age > or = 40) showed a significantly higher prevalence of MCSL than younger patients. There was no significant difference between male and female patients. The prevalence of MCSL was significantly higher (52.4%) in ligament ossification diseases than in disc herniation or spinal stenosis.
CONCLUSION
Degenerative spinal diseases showed a high prevalence of MCSL, especially in old ages and ligament ossification diseases. WSST2I is useful for diagnosing coexisting spinal diseases and to avoid missing a significant cord-compressing lesion.

Keyword

Spine; magnetic resonance imaging; whole body imaging

MeSH Terms

Adult
Aged
Aged, 80 and over
Female
Humans
Intervertebral Disk Displacement/diagnosis
Magnetic Resonance Imaging/*methods
Male
Middle Aged
Prevalence
Spinal Diseases/classification/*diagnosis
Spinal Stenosis/diagnosis
Young Adult

Figure

• 

  Fig. 1 Grading of coexisting spinal lesions on sagittal T2-weighted magnetic resonance images. Grade 0: no thecal sac compression (no coexisting lesion). Grade 1: minimal subarachnoid space compression. Grade 2: mild cord compression (thecal sac compression < 50% in the lumbar area). Grade 3: moderate or cord signal change (thecal sac compression ≥ 50% in the lumbar area).

• 

  Fig. 2 The grades and prevalence of coexisting lesions found on whole spine sagittal T2-weighted images (WSST2I) in 362 patients. Overall prevalence of meaningful coexisting spine lesions (MCSL) (grades 2 and 3) diagnosed by WSST2I was 31.1%.

• 

  Fig. 3 The prevalence of meaningful coexisting spine lesions (MCSL) according to age, gender, and primary spine lesions. (A) The prevalence of MCSL was significantly increased in patients aged 40 years or older compared with younger patients (p = 0.004). (B) There was no significant difference in the prevalence of MCSL between male and female groups. (C) Ligament ossification diseases showed a significantly higher prevalence of MCSL compared with other degenerative groups such as disc herniation or degenerative stenosis (p = 0.036). DH, disc herniation; DS, degenerative stenosis; LO, ligament ossification disease. *indicates statistically significant difference.

• 

  Fig. 4 WSST2I of a 78-year-old man with leg pain shows a lumbar stenosis at L2-5 (lower arrow), a cervical stenosis compressing the spinal cord at C6-7 (upper arrow) and mild thoracic stenosis at T4-5 (middle arrow). Cervical and lumbar lesions were surgically treated. WSST2I, whole spine sagittal T2-weighted images.

• 

  Fig. 5 Lumbar magnetic resonance imaging (MRI) and whole spine sagittal T2-weighted images (WSST2I) of a 60-year-old man with left leg pain. (A) The preoperative lumbar MRI showed lumbar disc herniation at the L5-S1 level. (B) WSST2I showed no abnormal finding at the surgery site (lower arrow) but an intradural extramedullary tumor (upper arrow) compressing the spinal cord at C4-5. Symptoms improved after tumor removal.

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