• Derek T Cawley, Andrew Simpkin, Elizabeth Abrahim, Thomas Doyle, Nada Elsheikh, John Fallon, Mohammed Habash, Rou Jiing Phua, Jaimie Langille, Elvis Matini, Conor McNamee, Fayhaa Mohamed, Cliona Nic Gabhann, Ali Noorani, Jieun Oh, Padraig O'Reilly, David O'Sullivan, and Aiden Devitt.
• Department of Surgery, University of Galway, Republic of Ireland.
• Spine. 2024 Aug 15; 49 (16): 113011361130-1136.

Study DesignObservational serial computed tomography (CT) analysis of the lumbar spine in a normal-aging population.ObjectiveTo assess the natural history of the intradiscal vacuum phenomenon (IDVP) and its role in disc degeneration.BackgroundThe natural history of disc degeneration is well described but our understanding of the end stage of pathogenesis remains incomplete. Magnetic resonance imaging loses accuracy with advanced degeneration, becoming hyporesonant and indistinct. Cadaveric specimens display adaptive changes in the disc with loss of the hydrostatic capacity of the nucleus, increased intradiscal clefts, and endplate impermeability. IDVP is associated with advanced disc degeneration and CT is the optimal modality to visualize this, yet these insights remain unreported.Patients And MethodsPatients only included historic CT abdomen scans of those over 60 years of age without acute or relevant spinal pathology, with a diagnosis of at least one level with IDVP on the original CT scan, and all of whom had a similar scan >7 years later. A history of clinically significant back pain was also recorded.ResultsCT scans included 360 levels in 29 males and 31 females (mean: 68.9 y), displaying 82 levels of IDVP, with a second scan included after a mean of 10.3 years. Most levels displayed the same level of severity (persisted, 45) compared with where some progressed (26), regressed (8), and fused (3; P < 0.01). There was also an increased incidence, 37/60 (62%) of developing IDVP at another level. Disc heights were reduced with increased severity of IDVP. A record of back pain was evident in 31/60 patients, which was not significantly worse in those with worsening severity or additional level involvement over the study period.ConclusionAs disc degeneration advances, the associated IDVP persists in most cases, displaying a plateauing of severity over long periods, but rarely with progression to autofusion.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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