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J Bone Joint Surg Am. 2018 May 16;100(10):843-849. doi: 10.2106/JBJS.17.01347.

A 20-Year Prospective Longitudinal Study of Degeneration of the Cervical Spine in a Volunteer Cohort Assessed Using MRI: Follow-up of a Cross-Sectional Study.

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Departments of Orthopedic Surgery (K.D., E.O., N.F., M.N., M.M., and K.W.) and Diagnostic Radiology (H.F.), Keio University School of Medicine, Tokyo, Japan.
Department of Environmental and Occupational Health, School of Medicine, Toho University, Tokyo, Japan.
Department of Orthopedic Surgery, Isehara Kyodo Hospital, Isehara, Japan.
Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Japan.
Department of Orthopaedic Surgery, Spine Center, Sanokousei General Hospital, Sano, Japan.
Department of Orthopaedic Surgery, Fujita Health University, Toyoake, Japan.



Few studies have addressed in detail long-term degenerative changes in the cervical spine. In this study, we evaluated the progression of degenerative changes of the cervical spine that occurred over a 20-year period in an originally healthy cohort. We also sought to clarify the relationship between the progression of cervical degenerative changes and the development of clinical symptoms.


For this prospective follow-up investigation, we recruited 193 subjects from an original cohort of 497 participants who had undergone magnetic resonance imaging (MRI) of the cervical spine between 1993 and 1996. The subjects were asked about the presence or absence of cervical spine-related symptoms. Degenerative changes of the cervical spine were assessed on MRI using an original numerical grading system. The relationship between the progression of degenerative changes and the onset of clinical symptoms was evaluated by logistic regression analysis.


Degeneration in the cervical spine was found to have progressed in 95% of the subjects during the 20-year period. The finding of a decrease in signal intensity of the intervertebral disc progressed in a relatively high proportion of the subjects in all age groups and occurred with similar frequency (around 60%) at all intervertebral disc levels. The rate of progression of other structural failures on MRI increased with age and was highest at C5-C6. The progression of foraminal stenosis was associated with the onset of upper-limb pain (odds ratio, 4.71 [95% confidence interval, 1.02 to 21.7]).


A progression of degenerative changes in the cervical spine on MRI over the 20-year period was detected in nearly all subjects. There was no relationship between the progression of degeneration on MRI and the development of clinical symptoms, with the exception of an association found between foraminal stenosis and upper-limb pain.


Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.


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