New treatments and imaging strategies in degenerative disease of the intervertebral disks.

Magnetic resonance (MR) imaging in patients with persistent low back pain and sciatica effectively demonstrates spine anatomy and the relationship of nerve roots and intervertebral disks. Except in cases with nerve root compression, disk extrusion, or central stenosis, conventional anatomic MR images do not help distinguish effectively between painful and nonpainful degenerating disks. Hypoxia, inflammation, innervation, accelerated catabolism, and reduced water and glycosaminoglycan content characterize degenerated disks, the extent of which may distinguish nonpainful from painful ones. Applied to the spine, "functional" imaging techniques such as MR spectroscopy, T1ρ calculation, T2 relaxation time measurement, diffusion quantitative imaging, and radio nucleotide imaging provide measurements of some of these degenerative features. Novel minimally invasive therapies, with injected growth factors or genetic materials, target these processes in the disk and effectively reverse degeneration in controlled laboratory conditions. Functional imaging has applications in clinical trials to evaluate the efficacy of these therapies and eventually to select patients for treatment. This report summarizes the biochemical processes in disk degeneration, the application of advanced disk imaging techniques, and the novel biologic therapies that presently have the most clinical promise.

T2 relaxation times of intervertebral disc tissue correlated with water content and proteoglycan content.

STUDY DESIGN: Human and bovine cadaver study in which biochemical measurements and magnetic resonance (MR) imaging of intervertebral discs were correlated. OBJECTIVE: To measure the correlations between T2 relaxation time with water and proteoglycan (PG) content of intervertebral discs. SUMMARY OF BACKGROUND DATA: Measuring T2 relaxation times may provide an accurate noninvasive method of detecting changes in disc water content and biochemistry due to aging or degeneration. Previous studies to validate the use of T1 or T2 relaxation times of intervertebral disc tissue have used MR relaxometers, lower field strength imagers, and in 1 case a 1.5-T imager. The dependence of T2 relaxation times on water and PG content needs further validation in high field clinical MR imagers. METHODS: Multiecho MR images were obtained in 14 calf and 5 human cadaver discs. T2 relaxation times were calculated voxel by voxel for nucleus and anulus regions by fitting the decay of the signal intensity to an exponential model. Water and PG content were measured in samples of nucleus and anulus corresponding to the location of the T2 measurements. T2 relaxation times for calf and human specimens were correlated with water or PG content by regression analysis. RESULTS: T2 relaxation times correlated significantly with water content in human nucleus pulposus, human anulus fibrosus, and calf anulus. T2 relaxation time correlated significantly with PG content only in the calf anulus. When the human and calf nucleus and anulus specimens were combined, T2 relaxation times correlated strongly with water (R = 0.81, P < 0.001) and less strongly with PG (R = 0.57, P < 0.001) content. CONCLUSION: T2 relaxation times of intervertebral disc anulus fibrosus and nucleus pulposus correlate strongly with water content and weakly with PG content.