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The Journal of Bone and Joint Surgery, Vol 72, Issue 8 1178-1184, Copyright © 1990 by Journal of Bone and Joint Surgery, Inc
Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects. A prospective investigation
SD Boden, PR McCowin, DO Davis, TS Dina, AS Mark and S Wiesel
Department of Orthopaedic Surgery, George Washington University Medical Center, Washington, D.C. 20037.
Previous investigations with plain radiography, myelography, and computed
tomography have shown that degenerative disease of the cervical spine
frequently occurs in the absence of clinical symptoms. We studied the
magnetic resonance-imaging scans of sixty-three volunteers who had no
history of symptoms indicative of cervical disease. The scans were mixed
randomly with thirty-seven scans of patients who had a symptomatic lesion
of the cervical spine, and all of the scans were interpreted independently
by three neuroradiologists. The scans were interpreted as demonstrating an
abnormality in 19 per cent of the asymptomatic subjects: 14 per cent of
those who were less than forty years old and 28 per cent of those who were
older than forty. Of the subjects who were less than forty, 10 per cent had
a herniated nucleus pulposus and 4 per cent had foraminal stenosis. Of the
subjects who were older than forty, 5 per cent had a herniated nucleus
pulposus; 3 per cent, bulging of the disc; and 20 per cent, foraminal
stenosis. Narrowing of a disc space, degeneration of a disc, spurs, or
compression of the cord were also recorded. The disc was degenerated or
narrowed at one level or more in 25 per cent of the subjects who were less
than forty years old and in almost 60 per cent of those who were older than
forty. The prevalence of abnormal magnetic-resonance images of the cervical
spine as related to age in asymptomatic individuals emphasizes the dangers
of predicating operative decisions on diagnostic tests without precisely
matching those findings with clinical signs and symptoms.
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