Intradiscal vacuum phenomenon matches lumbar spine degeneration patterns in an ageing population

• Published in: European spine journal Vol. 33; no. 5; pp. 2014 - 2021
• Main Authors: Cawley, Derek T., Simpkin, Andrew, Abrahim, Elizabeth, Doyle, Thomas, Elsheikh, Nada, Fallon, John, Habash, Mohammed, Phua, Rou Jiing, Langille, Jaimie, Matini, Elvis, McNamee, Conor, Mohamed, Fayhaa, Gabhann, Cliona Nic, Noorani, Ali, Oh, Jieun, O’Reilly, Padraig, O’Sullivan, David, Devitt, Aiden
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-05-2024; Springer Nature B.V
• Subjects: Aging; Degeneration; Intervertebral discs; Medicine; Medicine & Public Health; Neurosurgery; Original Article; Spine (lumbar); Spondylolisthesis; Surgical Orthopedics; Vacuum; Vertebrae; Lumbar lordosis; Vacuum; Pelvic incidence; Disc degeneration; Adult deformity
• ISSN: 0940-6719; 1432-0932; 1432-0932
• DOI: 10.1007/s00586-024-08174-0

Purpose
Intra-Discal Vacuum phenomenon (IDVP) is well-recognised, yet poorly visualised and poorly understood radiological finding in disc degeneration, particularly with regard to its role in spinal alignment. CT analysis of the lumbar spine in an aging population aims to identify patterns associated with IDVP including lumbopelvic morphology and associated spinal diagnoses.
Methods
An analysis was performed of an over-60s population sample of 2020 unrelated abdominal CT scans, without acute spinal presentations. Spinal analysis included sagittal lumbopelvic reconstructions to assess for IDVP and pelvic incidence (PI). Subjects with degenerative pathologies, including previous vertebral fractures, auto-fusion, transitional vertebrae, and listhesis, were also selected out and analysed separately.
Results
The prevalence of lumbar spine IDVP was 50.3% (955/1898) and increased with age (125 exclusions). This increased in severity towards the lumbosacral junction (L1L2 8.3%, L2L3 10.9%, L3L4 11.5%, L4L5 23.9%, and L5S1 46.3%). A lower PI yielded a higher incidence of IDVP, particularly at L5S1 (
p
 < 0.01). A total of 292 patients had IDVP with additional degenerative pathologies, which were more likely to occur at the level of isthmic spondylolisthesis, adjacent to a previous fracture or suprajacent to a lumbosacral transitional vertebra (
p
 < 0.05).
Conclusions
This study identified the prevalence and severity of IDVP in an aging population. Sagittal patterns that influence the pattern of IVDP, such as pelvic incidence and degenerative pathologies, provide novel insights into the function of aging spines.