Multimodal Assessment of Spinal Degeneration: Correlation among Radiological, Macroscopic and Microscopic Evaluation Scores

Multimodal Assessment of Spinal Degeneration

Abstract

Background: Spinal degeneration is a complicated and multifactorial process that is associated with chronic pain and disability. To understand its exact pathogenesis, a comprehensive multimodal (radiological, macroscopic, and microscopic) approach is required that integrates evaluations to elucidate the underlying pathophysiology. Objective: To assess lumbar spinal degeneration through radiological, macroscopic, and microscopic approaches, analyze age- and level-related variations, and establish correlations among modalities to refine diagnosis and guide targeted therapies. Study Design: Cross-sectional analytical study. Settings: Department of Anatomy, University of Health Sciences, Lahore Pakistan. Duration: Twelve months from March 12, 2022 to March 11, 2023. Methods: 72 lumbar human endplate and intervertebral disc composites were taken from adult male cadavers which were free from spine deformity, fracture, infection, or metastasis. After X-ray imaging, the individual motion segments were separated and were cut mid-sagittally (Fig. 1), and both endplates and IVDs were assessed for macroscopic grades and microscopic scores and grades. Results: Significant increase in the mean radiological, macroscopic, and microscopic degeneration scores with age and spinal level. Sclerosis increased significantly with age while osteophytes increased with spinal levels. Significant correlations were observed among radiological, macroscopic, and microscopic scores (p<0.001). Macroscopic findings include fissures, fibrosis, brown discoloration, and calcification. Histological evaluation revealed advanced degeneration characterized by fissures, herniation, calcification, and matrix disorganization. Conclusion: Multimodal assessment offers a robust framework for understanding spinal degeneration, facilitating accurate diagnosis, and the development of targeted therapeutic strategies.