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Two trajectories of lumbar disc degeneration from adolescence to adulthood: a 23-year longitudinal MRI study

Year: 2025

Type: article

Abstract: PURPOSE: Disc degeneration (DD) increases with age, but its onset and early progression remain poorly understood. This longitudinal study examined DD progression from adolescence into adulthood in healthy individuals. METHODS: Forty participants with magnetic resonance imaging (MRI) at ages 11, 19, and 34 were included. Discs were graded using the Pfirrmann classification, and a Pfirrmann Summary Score (PSS, range 5-25) was calculated by summing individual disc grades. The primary outcome was progression of overall DD burden, defined as an increase in PSS. Participants were grouped by PSS at age 11: PSS = 5 (later-onset) vs. PSS 6 or higher (early-onset). Presence of at least one disc graded Pfirrmann 3 or higher was assessed at ages 19 and 34. RESULTS: Demographics, anthropometrics, and clinical characteristics were comparable between the groups. All participants showed DD progression. Early-onset individuals had higher PSS at ages 19 and 34, whereas later-onset individuals exhibited greater PSS change over time. By age 19, early-onset participants more frequently had at least one Pfirrmann 3 or higher disc; by age 34, occurrence was similar (72% vs. 73%). Later-onset DD was localized to lower lumbar spine, whereas early-onset DD was more widespread. DD progression trajectories were not associated with low back pain (LBP) by age 34. CONCLUSION: Progression of DD is an inevitable but individually variable process. Early-onset DD appears to lead to a more widespread pattern, whereas later-onset DD progresses more rapidly but remains confined to the lower lumbar spine. No direct relationship between structural progression and LBP could be determined.

Source: European Spine Journal

DOI: 10.1007/s00586-025-09641-y

Authors: Teija Lund, Anni Aavikko, Leena Ristolainen, Hannu Kautiainen, Martina Lohman, Dietrich Schlenzka