On Magnetic Resonance Imaging of Intervertebral Disc Aging
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LETTER TO THE EDITOR
On Magnetic Resonance Imaging of Intervertebral Disc Aging Yı` Xia´ng J. Wa´ng1
Ó Springer International Publishing Switzerland 2016
Dear Editor I read with interest the article recently published in Sports Medicine by Belavy´ et al. [1]. This article further illustrates the need for and importance of critical literature review and appraisal in light of the current publishing culture. It highlights that some studies of imaging readouts suffer from the lack of a true multidisciplinary approach, and that statistical rigor is not always ensured [2–5]. Publishing unclear results can sometimes increase the difficulties of finding scientific truth [5–7]. I would like to make some comments on magnetic resonance (MR) imaging of lumbar intervertebral disc aging. Belavy´ et al. [1] noted that disc degeneration is virtually nonexistent in young individuals. However, this is probably an overstatement. Both Miller et al. [8] and Łebkowski [9] reported that disc degeneration can be observed in the second decade of life. In an MR imaging survey of young adults aged 20–22 years, lumbar disc degeneration was seen more frequently in men, presumably because of greater physical and sports activities in men than in women [10]. Estrogen can influence disc degeneration [11]. Compared with men, women have accelerated disc degeneration after menopause, and this may have an impact on the higher low back pain prevalence seen in women at this stage of life [12]. Belavy´ et al. [1] also noted that students in their early twenties have smaller disc heights than people aged 40–45 & Yı` Xia´ng J. Wa´ng [email protected] 1
Department of Imaging and Interventional Radiology, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR
years, indicating that some development still takes place between these ages. However, one of the important factors affecting disc height is the strength of the vertebral endplate, which is compromised as bone mineral density (BMD) decreases and osteopenia/osteoporosis develops [13, 14]. The expansion of the disc into the vertebral body secondary to a weakened endplate is likely to be a passive process. When only the middle height of the disc is considered, it has been noted that osteopenia/osteoporosis is associated with a larger disc, and therefore it has been suggested that osteoporosis might be beneficial to the disc [15]. However, volumetric MR imaging has shown that although lower BMD is associated with greater disc middle height and increased biconvexity, it is accompanied by a decrease in anterior and posterior disc heights, reduced anterior–posterior dimensions, and a smaller disc volume. In fact, lower BMD values might negatively impact the disc [16, 17]. With respect to radiological grading, Belavy´ et al. [1] listed the five-level grading scheme proposed by Pfirrmann et al. [18]. To increase discriminatory power, an eight-level grading scheme has been proposed and applied in clinical studies [19]. A more sophisti
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