Skip to main content
SpringerLink
Log in

Qualitative and quantitative assessment of degeneration of cervical intervertebral discs and facet joints

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

An Erratum to this article was published on 27 January 2009

Abstract

Degeneration of intervertebral discs and facet joints is one of the most frequently encountered spinal disorders. In order to describe and quantify degeneration and evaluate a possible relationship between degeneration and biomechanical parameters, e.g., the intervertebral range of motion and intradiscal pressure, a scoring system for degeneration is mandatory. However, few scoring systems for the assessment of degeneration of the cervical spine exist. Therefore, two separate objective scoring systems to qualitatively and quantitatively assess the degree of cervical intervertebral disc and facet joint degeneration were developed and validated. The scoring system for cervical disc degeneration consists of three variables which are individually scored on neutral lateral radiographs: “height loss” (0–4 points), “anterior osteophytes” (0–3 points) and “endplate sclerosis” (0–2 points). The scoring system for facet joint degeneration consists of four variables which are individually scored on neutral computed tomography scans: “hypertrophy” (0–2 points), “osteophytes” (0–1 point), “irregularity” on the articular surface (0–1 point) and “joint space narrowing” (0–1 point). Each variable contributes with varying importance to the overall degeneration score (max 9 points for the scoring system of cervical disc degeneration and max 5 points for facet joint degeneration). Degeneration of 20 discs and facet joints of 20 patients was blindly assessed by four raters: two neurosurgeons (one senior and one junior) and two radiologists (one senior and one junior), firstly based on first subjective impression and secondly using the scoring systems. Measurement errors and inter- and intra-rater agreement were determined. The measurement error of the scoring system for cervical disc degeneration was 11.1 versus 17.9% of the subjective impression results. This scoring system showed excellent intra-rater agreement (ICC = 0.86, 0.75–0.93) and excellent inter-rater agreement (ICC = 0.78, 0.64–0.88). Surgeons as well as radiologists and seniors as well as juniors obtained excellent inter- and intra-rater agreement. The measurement error of the scoring system for cervical facet joint degeneration was 20.1 versus 24.2% of the subjective impression results. This scoring system showed good intra-rater agreement (ICC = 0.71, 0.42–0.89) and fair inter-rater agreement (ICC = 0.49, 0.26–0.74). Both scoring systems fulfilled the criteria for recommendation proposed by Kettler and Wilke. Our scoring systems can be reliable and objective tools for assessing cervical disc and facet joint degeneration. Moreover, the scoring system of cervical disc degeneration was shown to be experience- and discipline-independent.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11

Similar content being viewed by others

References

  1. Bland JM, Altman DG (1996) Measurement error and correlation coefficients. BMJ 313(7048):41–42

    PubMed  CAS  Google Scholar 

  2. Bland JM, Altman DG (1996) Measurement error proportional to the mean. BMJ 313:7049–7106

    Google Scholar 

  3. Butler D, Trafimow JH, Andersson GB, McNeill TW, Huckman MS (1990) Discs degenerate before facets. Spine 15(2):111–113. doi:10.1097/00007632-199002000-00012

    Article  PubMed  CAS  Google Scholar 

  4. Côté P, Cassidy JD, Yong-Hing K, Sibley J, Loewy J (1997) Apophysial joint degeneration, disc degeneration, and sagittal curve of the cervical spine. Can they be measured reliably on radiographs? Spine 22(8):859–864. doi:10.1097/00007632-199704150-00007

    Article  PubMed  Google Scholar 

  5. Christe A, Läubli R, Guzman R, Berlemann U, Moore RJ, Schroth G et al (2005) Degeneration of the cervical disc: histology compared with radiography and magnetic resonance imaging. Neuroradiology 47(10):721–729. doi:10.1007/s00234-005-1412-6

    Article  PubMed  CAS  Google Scholar 

  6. Derian TC (1994) Adjacent disc degeneration in patients with prior spinal fusion procedures. Spine 19(19):2244–2245. doi:10.1097/00007632-199410000-00024

    Article  PubMed  CAS  Google Scholar 

  7. Fleiss J (1986) Reliability of measurement. In: The design and analysis of clinical experiments. Wiley, New York, pp 1–32

  8. Fujiwara A, Lim TH, An HS, Tanaka N, Jeon CH, Andersson GB et al (2000) The effect of disc degeneration and facet joint osteoarthritis on the segmental flexibility of the lumbar spine. Spine 25(23):3036–3044. doi:10.1097/00007632-200012010-00011

    Article  PubMed  CAS  Google Scholar 

  9. Gries NC, Berlemann U, Moore RJ, Vernon-Roberts B (2000) Early histologic changes in lower lumbar discs and facet joints and their correlation. Eur Spine J 9(1):23–29. doi:10.1007/s005860050004

    Article  PubMed  CAS  Google Scholar 

  10. Kellgren J, Jeffrey M, Ball J (1963) The epidemiology of chronic rheumatism, vol. II. Blackwell, Oxford, pp 14–19

  11. Kettler A, Rohlmann F, Neidlinger-Wilke C, Werner K, Claes L, Wilke HJ (2006) Validity and interobserver agreement of a new radiographic grading system for intervertebral disc degeneration. Part II. Cervical spine. Eur Spine J 15(6):732–741. doi:10.1007/s00586-005-1037-9

    Article  PubMed  Google Scholar 

  12. Kettler A, Wilke HJ (2006) Review of existing grading systems for cervical or lumbar disc and facet joint degeneration. Eur Spine J 15(6):705–718. doi:10.1007/s00586-005-0954-y

    Article  PubMed  Google Scholar 

  13. Kolstad F, Myhr G, Kvistad KA, Nygaard OP, Leivseth G (2005) Degeneration and height of cervical discs classified from MRI compared with precise height measurements from radiographs. Eur J Radiol 55(3):415–420. doi:10.1016/j.ejrad.2005.02.005

    Article  PubMed  Google Scholar 

  14. Kumaresan S, Yoganandan N, Pintar FA, Maiman DJ, Goel VK (2001) Contribution of disc degeneration to osteophyte formation in the cervical spine: a biomechanical investigation. J Orthop Res 19(5):977–984. doi:10.1016/S0736-0266(01)00010-9

    Article  PubMed  CAS  Google Scholar 

  15. Lewin T (1964) Osteoarthritis in lumbar synovial joints. a morphologic study. Acta Orthop Scand Suppl S73:1–12

    Google Scholar 

  16. Miyazaki M, Hong SW, Yoon SH, Morishita Y, Wang JC (2008) Reliability of a magnetic resonance imaging-based grading system for cervical intervertebral disc degeneration. J Spinal Disord Tech 21(4):288–292. doi:10.1097/BSD.0b013e31813c0e59

    Article  PubMed  Google Scholar 

  17. Moore RJ, Crotti TN, Osti OL, Fraser RD, Vernon-Roberts B (1999) Osteoarthrosis of the facet joints resulting from anular rim lesions in sheep lumbar discs. Spine 24(6):519–525. doi:10.1097/00007632-199903150-00003

    Article  PubMed  CAS  Google Scholar 

  18. Shrout P, Fleiss J (1979) Intraclass correlations: uses in assessing rater reliability. Psychol Bull 86(2):420–428. doi:10.1037/0033-2909.86.2.420

    Article  PubMed  CAS  Google Scholar 

  19. Swanepoel MW, Adams LM, Smeathers JE (1995) Human lumbar apophyseal joint damage and intervertebral disc degeneration. Ann Rheum Dis 54(3):182–188. doi:10.1136/ard.54.3.182

    Article  PubMed  CAS  Google Scholar 

  20. Szpalski M, Gunzburg R, Mayer M (2002) Spine arthroplasty: a historical review. Eur Spine J 11(S2):S65–S84

    PubMed  Google Scholar 

  21. Tertti M, Paajanen H, Laato M, Aho H, Komu M, Kormano M (1991) Disc degeneration in magnetic resonance imaging a comparative biochemical, histologic, and radiologic study in cadaver spines. Spine 16(6):629–634. doi:10.1097/00007632-199106000-00006

    Article  PubMed  CAS  Google Scholar 

  22. Tian L (2005) On confidence intervals of a common intraclass correlation coefficient. Stat Med 24(21):3311–3318. doi:10.1002/sim.2145

    Article  PubMed  Google Scholar 

  23. Vernon-Roberts B, Pirie CJ (1977) Degenerative changes in the intervertebral discs of the lumbar spine and their sequelae. Rheumatol Rehabil 16(1):13–21

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

Medtronic Sofamor Danek Inc., USA, is acknowledged for the institutional research and education grant.

Author information

Authors and Affiliations

  1. Division of Biomechanics and Engineering Design, KULeuven, Celestijnenlaan 300C, PB 2419, 3001, Heverlee, Belgium

    Joris Walraevens & Jos Vander Sloten

  2. Division of Experimental Neurosurgery and Neuroanatomy, KULeuven, University Hospital Gasthuisberg, Leuven, Belgium

    Baoge Liu & Jan Goffin

Authors
  1. Joris Walraevens
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Baoge Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jos Vander Sloten
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jan Goffin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joris Walraevens.

Additional information

An erratum to this article can be found at http://dx.doi.org/10.1007/s00586-009-0887-y

Rights and permissions

Reprints and permissions

About this article

Cite this article

Walraevens, J., Liu, B., Vander Sloten, J. et al. Qualitative and quantitative assessment of degeneration of cervical intervertebral discs and facet joints. Eur Spine J 18, 358–369 (2009). https://doi.org/10.1007/s00586-008-0820-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-008-0820-9

Keywords

Search

Navigation