Related Experiment Videos
Temporal association of annular tears and nuclear degeneration: lessons from the pediatric population
A Sharma1, M S Parsons, T K Pilgram
1Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd., St. Louis, MO 63110, USA. sharmaa@mir.wustl.edu
Insights
In children, radial annular tears are linked to nuclear degeneration, suggesting tears often precede early disk degeneration. This association is evident even in young patients.
Area of Science:
- Pediatric radiology
- Spinal imaging
- Degenerative disc disease
Background:
- Adult studies link annular tears and nuclear degeneration.
- Pediatric data on this association is limited.
- Understanding early disc degeneration is crucial.
Purpose of the Study:
- Investigate the association between annular tears and nuclear degeneration in children.
- Determine if annular tears precede nuclear degeneration in pediatric patients.
- Clarify the early stages of disc degeneration.
Main Methods:
- Retrospective review of 26 children with back pain and disc pathology.
- Independent neuroradiologist evaluation of T12-S1 intervertebral discs.
- Assessment of annular tears (radial/nonradial) and disc degeneration (Pfirrmann scale, signal intensity).
Main Results:
- Radial tears were associated with significantly higher nuclear degeneration grades and signal intensity loss.
- Discs with radial tears showed more degeneration than those with nonradial tears or no tears.
- Most discs with significant signal intensity loss (>3) had an intact annulus, while 30.3% of radial tears had normal signal intensity.
Conclusions:
- Nuclear degeneration in children is associated with radial annular tears.
- Annular tears, particularly radial tears, appear to precede or coincide with early nuclear degeneration in pediatric discs.
- Disc degeneration in children rarely occurs without associated annular tears.
Background And Purpose:
Studies done mainly in adults have shown an association between annular tears and nuclear degeneration. We wanted to study this association in the pediatric population to better understand the natural history of disk degeneration in its early stages. We hypothesized that this association is discernible even at a young age and that annular tears precede nuclear degeneration.
Materials And Methods:
Twenty-six children with back pain and known disk pathology were identified from our radiology report data base. Two neuroradiologists independently evaluated T12 through S1 intervertebral disks in these images. One reader evaluated the disks for the presence and type of annular tears. The other reader graded the signal intensity of the disks on an ordinal scale and the extent of disk degeneration on the Pfirrmann scale. Mean degeneration and signal-intensity grades were compared for disks with radial tears, disks with nonradial tears, and disks without annular tears.
Results:
Fifty-six disks had radial tears. These demonstrated significantly higher nuclear degeneration grades and greater signal-intensity loss than disks with nonradial tears or disks with no annular tears. About one third (30.3%) of the disks with radial tears had a normal nuclear signal intensity. Only 3% of disks with a signal-intensity grade of >/=3 had an intact annulus.
Conclusions:
Nuclear degeneration in children is associated with radial annular tears and rarely occurs in the absence of annular tears.
Related Concept Videos
01:21Aneurysm II: Clinical Manifestations and Diagnostic Studies
01:27Degenerative Disc Disease I: Introduction