Waleed Brinjikji, Abstract Co-Author: Nothing to Disclose

Patrick H. Luetmer MD, Presenter: Nothing to Disclose

Bryan A. Comstock, Abstract Co-Author: Nothing to Disclose

Brian W. Bresnahan PhD, Abstract Co-Author: Stockholder, Johnson & Johnson Investigator, General Electric Company Consultant, General Electric Company Consultant, Johnson and Johnson Consultant, Novartis AG

Linda Chang Chen MD, Abstract Co-Author: Nothing to Disclose

Richard A. Deyo MD, MPH, Abstract Co-Author: Nothing to Disclose

Safwan Halabi MD, Abstract Co-Author: Nothing to Disclose

Judith Turner, Abstract Co-Author: Nothing to Disclose

Andrew Avins, Abstract Co-Author: Nothing to Disclose

Kathryn M. James, Abstract Co-Author: Nothing to Disclose

John Thomas Wald MD, Abstract Co-Author: Nothing to Disclose

David F. Kallmes MD, Abstract Co-Author: Research support, Terumo Corporation Research support, Covidien AG Research support, Sequent Medical, Inc Research support, Benvenue Medical, Inc Consultant, General Electric Company Consultant, Covidien AG Consultant, Johnson & Johnson

Jeffrey Gil Jarvik MD, MPH, Abstract Co-Author: Stockholder, PhysioSonics, Inc Consultant, HealthHelp, LLC Co-editor, Springer Science+Business Media Deutschland GmbH Royalties, Springer Science+Business Media Deutschland GmbH Travel support, General Electric Company

Imaging evidence of spine degeneration influences medical decision making in back pain patients. Prior studies demonstrate that degenerative changes are highly prevalent in asymptomatic individuals. We performed a systematic review to study the prevalence of imaging evidence of spine degeneration in asymptomatic individuals.  Findings from this systematic review are being used to help physicians with clinical decision making for low back pain patients in A Pragmatic Trial of Lumbar Image Reporting with Epidemiology (LIRE); a multicenter randomized controlled trial aimed at reducing testing and unnecessary treatments for low back pain.

We performed a comprehensive literature review for articles describing the prevalence of the following relevant imaging findings in asymptomatic individuals: disc degeneration, disc signal loss, disc height loss, disc bulge, disc protrusion, annular fissures, facet degeneration, and spondylolisthesis. We selected age groupings of 18-39, 40-59 and 60+ years old for age-specific prevalence estimates. For each imaging finding, we fit a generalized non-linear mixed effects model for the age-specific prevalence estimate clustering on study and adjusting for the midpoint of the reported age interval.

Twenty-seven articles were included in our study. Among asymptomatic individuals, disc degeneration was present in 53% of individuals under 40, 75% of individuals 40-59 and 91% of individuals ≥60 years old. Disc signal loss was present in 39% of individuals 18-39, 60% of individuals 40-59 and 89% of individuals ≥60 years old. Disc bulge was present in 44% of individuals under 40, 60% of individuals 40-59 and 75% of individuals ≥60 years old. Disc protrusion was present in 32% of individuals 18-39, 35% of individuals 40-59 and 36% of individuals ≥60 years old. Facet degeneration was present in 20% of individuals 18-39, 20% of individuals 40-59 and 55% of individuals ≥60 years old.. Annular fissures were present in 12% of individuals 18-39, 20% of individuals 40-59 and 35% of individuals ≥60 years old.

Imaging evidence of spine degeneration is present in up to 90% of asymptomatic individuals. Many imaging-based degenerative features may be a part of normal aging and unassociated with pain.

The results from this systematic review strongly suggest that normal age-related changes must be considered when interpreting lumbar spine imaging studies.

Brinjikji, W, Luetmer, P, Comstock, B, Bresnahan, B, Chen, L, Deyo, R, Halabi, S, Turner, J, Avins, A, James, K, Wald, J, Kallmes, D, Jarvik, J, Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14013440.html