Hydrostatic integrity of the intervertebral disc assessed by MRI

Abstract

Hydrostatic integrity of the intervertebral disc (IVD) is lost during the process of degeneration. Invasive pressure profilometry (IPP) can quantify it, however, is not applicable for clinical use. We aimed to investigate correlations between IPP and MRI findings to assess non-invasive MRI based methods for prediction of hydrostatic integrity of the intervertebral disc. The pressure profiles of 39 lumbar spinal segments originating from 22 human cadavers were recorded during axial compression in the neutral, the flexed and the extended positions. Disc pressure profiles were measured and mathematically transformed to a novel metric that quantifies pressure profile heterogeneity across the disc. The relationship between pressure profile inhomogeneity (“pressure score”) and clinically established magnetic resonance-based classifications systems and demographic parameters was then tested using Spearman correlation tests. Pressure profile inhomogeneities were correlated with IVD degeneration (according to Pfirrmann, rho = 0.43, p = 0.006), endplate defects (according to Rajasekaran, rho = 0.39, p = 0.013), segmental degeneration (according to Farshad, rho = 0.41, p = 0.009) and age (rho = 0.32, p = 0.049). Modic changes per se did not affect the pressure profiles significantly (p = 0.23) and pressure scores did not correlate with BMI (rho = -0.21, p = 0.2). Heterogeneity of segmental IVD pressure profiles is a unique measure of disc function. We demonstrate that established clinical methods for MRI characterization of the intervertebral disc, the endplate and overall segmental degeneration all correlate with the hydrostatic integrity of the IVD and can be used for its assessment.