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I SCIENTIFIC PROGRAM ABSTRACTS

I PAPER #49 \., I ' '

; IIlGIi LUMBAR DISC DEGENERATION: INCIDENCE AND ETIOLOGy '^Ken Ilsu, MD, Janes Zuchernian, MD/ Jay Kaiser, MD,

-: 'Arbliur Wliite, MD, Jeraiie Schoffernian, MD.St. Mciry's Hospital Spine Center, San Francisco, CA.

! Disc patliologies involving the proxiinal levels of! the lumbar spJ.ne have not been appreciated as well prior}' to the clinical use of MRI scan. We have found tJie!' incidence of high lumbar disc lierniation and degenera- •

tion in back pain patients to be more cannon ttian previously believed. Our findings suggest tliat altered

^ nechanics are associated with these high disc lesions.!. 379 consecutive MRI with dual-echo images of tlie entire' lumbar spine were reviewed by tJ\e authors. All 379

•, patients presented witli back pain and/or leg pain; tJieywere interviewed ajid examined. Paiii drawings were can-pleted by all. There were 42 patients (11.1%) with discpaUiologies involving T12-L1, Ll-32, and/or L2-3 levels. ,

i 'IWo had hemiations of at least 5mn ah Ll-2 discs. IVro> had disc extrusions of at least 7iiin. at L2-3 level.

Isolated degenerative changes were noted in T12-L1 andLl-2 in one, T12-L1 and L3-4 in one, L2-3 and L3-4 inone. Severe degeneration of L2-3 disc wiUi tlie rest oflumbar discs being normal was found in one. The remaining 36 patients liad degenerative changes of the liigher

i discs with variable involvment of tlie lower lumhar discs.I Out of 12 spondylolestlieses of L5 on Si, 7 liad liigh disc• paUiologies at one or more levels presenting as skipped• legions; more severe high disc lesions were noted in

grade II slips. Isolated high disc degeneration is oftenassociated with pre-existing abnomialities such as end-

i plate defects, Scheuermann's disease, limbus vertebra, etc.,, and stressful cumulative work activities such as in

construction workers, airplane mechanics, etc.^High disc degeneration was noted above or below previousfractures. Higli disc involvment with diffuseclianges in lower lumbar spine was more camionly found inascending fashion in older age group, and in patientswho have had previous lower lumbar spine surgeries, priorfusions in particular.

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