Discussing news and issues in orthopedics and spine healthcare. This is Spine Talk. Hi,
I'm Dr. John Shim, and today we're going to talk about a very interesting topic,
and that's a topic about disc degeneration findings on MRIs of young
military recruits of the Italian Air Force. There was a study published in
June 2019 in one of the journals of spine, and it's about this very topic.
Jason, I hope you can kind of enlighten us on the topic, and what they found. All
right, so this the study very intriguing study that we looked at comes to us from
Naples, Italy. It was a cross-sectional study in
retrospective study of 350 Air Force cadets in Italy. The cadets ranged in age
from 18 to 22 years old. All of them underwent an MRI the
thoracic and lumbar spine - this was done over approximately a four year period.
The study protocol had two radiologists reviewing the studies to look at curve
abnormalities, structure abnormalities, spinal canal diameter, and degenerative
and spinal cord abnormalities. And the findings of the study kind of probably
surprised some is that 77% of the 350 cadets had some form of a structural
abnormality. This includes 49% with a disc bulge, and 38% with some type of
alteration of spinal curve, and 30% with disk desiccation. The authors of the
study concluded that the imaging findings are similar to that of an adult
population, and suggest the aging spine is morphologically appreciable in
immediate post-adolescent period. So Dr. Shim, based on the kind of the
findings of study - do the findings at all kind of surprise you in for this
very young cohort? Well, for me it's not a surprise. People have to understand we
see a very skewed population. People come to see a spinal specialist like me
because they're having pain. They don't come to me because they're not having
pain. So when we get tests it's almost rare that we ever see a normal MRI. What
does give me pause is that no number of these young healthy cadets - age
18 to 22 actually has some sort of finding abnormal on the MRI - 77% that's
3/4 of the population who are not having concerns had these findings. Slightly
higher than what I thought but this is more in light of what we kind of know
now. The natural history's people develop these degenerative findings or these
findings under MRIs, and we see them all the time.
So, 77% of this population had an abnormal finding despite being
asymptomatic. Yet we know that about 80% of the
population adult population develops back pain at some point in their life. As
a clinician, where do you draw the line and say that the changes that we see on
an MRI are truly age-related versus some type of precipitating event causing them?
Well, you know the statistic about 80% of people having some significant
debilitating spinal concern in their life. That's a pretty much accepted
principle. The question is how one how many of those complaints are actually
related to a disc problem, or how much is related to normal wear and tear of
arthritis to do up in the spine, or how much is it related to holes, and ligaments,
and tendons, and muscles of the spine? I think there's a combination of all those
things. MRIs are a very significant diagnostic study. It gives us a lot of
information. The question is is it giving us information that's relevant to that
person who's getting the MRI? If there's some sort of event that happened and
you're really concerned - you get x-rays, you see findings - I think the MRI is very
very helpful, and a physical exam will clue you in on should there be a major
finding on the MRI. So I think you have to take the MRI findings - a little grain
of salt. You have to put it together with what's going on with that person, what
happened to that person, and what are the physical exam findings. Do they have
numbness, do they have weakness to their muscles that we can detect, if they have
reflex changes that we can detect. That would clue us in on are these MRI
findings actually related to what's going on with that person right now. So
for these the the purpose of the study here.
So again it's really not clear from reading through the paper a couple times
here kind of the the overall intended purpose of this. You know this kind of
looks like they want to use this as a screening tool in this case for cadets
going into the Air Force. So when you tell an 18 to 22 year old that you have
some type of issue with your spine again they not haven't necessarily knee pain
but there's findings on the MRI. What does this do for the long term? Meaning,
are we gonna spend thousands and thousands of dollars we already know
billions of dollars are spent yearly on healthcare for spine related disorders?
Are those people more likely to be the ones that consume all the healthcare
dollars because they know early in life there is a problem with their spine? Well,
I mean you bring up a very interesting point in, and I'm not sure this has
really been researched. Because most of the research that we have in medicine is
geared towards trying to solve a problem. All right. A lot of the research is
actually fostered by entities that produce pharmaceutical or medicines,
produce devices to try to help people. So in a way a lot of these researchers are
geared towards finding a problem that we can fix. What we're saying is there's a
problem identified on a test that may not be the source of the complaint, but
now have we embedded a potential source of anxiety? My goodness, I'm 22 years old
and I have these findings in my spine. What's it gonna do to me long-term? Is
that going to cause more utilization of healthcare services down the road? Is
that gonna cause more angst and maybe increasing rates of disability and work
injures and what not? I don't know if the data is really out there yet, but from a
practical standpoint I think it probably does. There probably needs to be some
longitudinal research on that being done, but I can't really say for sure if
enough information has been provided for us to be able to make those conclusions.
Now overall again it's very intriguing study that a lot of kind of questions
this study can raise, but I think it's definitely some eye
opening statistics that this group of authors came up with in looking at the
MRI findings. Well, I'll tell you in the past historically in the 60's, we used to
x-ray people's backs before they're hired for some manual labor jobs and
whatnot. Well they stopped doing that because they realize x-ray findings that
by themselves do not really have bearing on how well a person will perform in
their job functions - even heavy labor functions. So, I'm not sure using this as
a screening tool to take people out of contention for certain things actually
makes sense. I don't know if this passed muster United States maybe a pass muster
in Italy. What I do know is we still don't know a lot about the unintended
consequences of testing. To give you an example there's a lot of information now
on laboratory testing. We know if you get 20 laboratory test there's a 5% chance
at any one of those laboratories being abnormal just because it's abnormal by
testing. So one out of 20 findings is not going to be abnormal. Then you have to
chase that finding to find out if that's real or not.
Well it turns out we increase the level of anxiety for a lot of these folks, and
there is studies showing that there's over utilization based on testing. So is
that over utilization of MRI testing actually causing long-term costs? Which I
think it does. More important, is it causing long-term psychologic anxieties, and
predisposing people to be concerned about things they shouldn't be concerned
about? These are very very important issues. I wish we had the answers. I think more
studies need to be done. The question is who's going to fund those studies, and is
there an incentive to fund those studies? Alright. So, this is Dr. Shim and Jason
Mazza. We're talking about the study. It's called the High Prevalence of Spinal
Magnetic Resonance Imaging Findings in Asymptomatic
Young Adults Aged 18 to 22 Cadets to an Air Force Flight. This was published in
the Journal of Spine in June of in the 2019. I found it kind of interesting. I
hope you enjoyed watching the video. If you like to find out more information
about our videos please subscribe to our station. Thank you.