Ahmad Fauzey, Kassim
(2010)
Changes in adolescent intervertebral discs, end plates and
bone marrow of lumbar spine in idiopatidc thoracic scoliosis
an mri based study.
Masters thesis, Universiti Sains Malaysia.
Abstract
Intervertebral disc degeneration is known to occur as early as the first decade in normal
individuals. In adolescent idiopathic thoracic scoliosis, the spinal curvature is thought to
impart mechanical stresses on the lumbar spine. This in theory would lead to early
degenerative discs changes, Modic changes and Schmorl 's nodes as part of the whole
degenerative process. Before the advent of magnetic resonance imaging (MRI), proper
assessment of the discs, end plates, vertebral bone marrow changes and Schmorl's nodes
were not possible. With the help of MRI, a more detailed and accurate assessment of the
intervertebral disc and vertebral bone marrow is now possible.
This was a cross sectional study with the aim to identify and grade lumbar intervertebral
discs, end plates, bone marrow changes and Schmorl's nodes in adolescent idiopathic
thoracic scoliosis patients. Lumbar MRI films from 40 patients totaling 200 discs were
recruited into this study during 6 month period. The patients' ages were 15.5 ± 2.7 years
old (range 10 to 20). The Cobb's angles average were 47.63° ± 14.1° (range 20° to 80°).
The patients were those attending Spine clinic, Hospital Universiti Sains Malaysia and
diagnosed with idiopathic thoracic scoliosis. MRI were ordered for them mainly due to
complaints of back pain, neurological deficit and others. MRI films were obtained from
the online database system and analyzed by a radiologist, looking for the changes
mentioned before. Thoracic scoliosis Cobb's angles were measured from patient's
AP(anteroposterior) radiological film of the spine. Demographic data regarding sex and
age were obtained from the patients' medical records. Our results showed that in
adolescent idiopathic thoracic scoliosis patients, all lumbar discs were affected by
degenerative changes mainly grade 2 and 3 in Pfmmann classification system. No disc was graded as nonnal (Pfimnann 1). Modic changes(l5%) and Schmorl's nodes(5%) are
not commonly found in the lumbar discs of idiopathic thoracic scoliosis. The severity of
thoracic spinal curvature was not proven to affect grades (Pfirnnann) of degenerative disc
changes, Modic changes and Schmorls nodes. (all p value >0.05)
We concluded that lumbar discs in adolescent idiopathic scoliosis with a single thoracic
curve are all affected by degenerative changes. The thoracic curvature was not proven to
have a direct effect on the severity of disc changes, Modic changes and Schmorl 's nodes.
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