JMIR Publications

ABSTRACT

Background:

Degenerative thoracic myelopathy (DTM) encompasses a spectrum of degenerative spinal pathologies that result in symptomatic thoracic spinal cord compression. Whilst widespread availability of magnetic resonance imaging (MRI) is beneficial for diagnosis, clinical history and examination remain as important as ever in localising neurological problems. This is particularly essential in the distinction between symptomatic pathology and the increasing burden of incidental findings that result from large volumes of imaging. The prevalence and spectrum of degenerative thoracic spinal pathology in healthy individuals is currently largely uncharacterised.

Objective:

The aim of this systematic review was therefore to synthesise available evidence on degenerative thoracic spinal pathologies on MRI in healthy individuals and to improve understanding of the natural history of DTM.

Methods:

A systematic review was registered with PROSPERO (CRD42023484442) and performed following PRISMA guidelines. MEDLINE and Embase were searched from inception to March 2025. All studies investigating degenerative thoracic spinal pathologies on MRI in healthy adults were eligible for inclusion. Duplicate title and abstract screening, data extraction and risk of bias assessments were conducted.

Results:

Of 3574 records screened, 11 studies satisfied eligibility criteria for inclusion in the final synthesis. There were seven cross-sectional studies, three case-control studies and one cohort study. A total of 3805 individuals were included: 40.3% (1533/3805) were male, with a mean age of 58.2 years. The most prevalent degenerative pathologies identified on MRI were multilevel (two or more consecutive or non-consecutive discs) disc degeneration (two studies; mean prevalence of 54.2%; range 50%-55%), single level disc degeneration (four studies; mean prevalence of 29.7%; range 7%-72.5%), ossification of the ligamentum flavum (two studies; mean prevalence of 7.2%; range 2.1%-11.9%), inflammatory end-plate changes (two studies; mean prevalence of 4.5%; range 3%-20%), and disc herniation (three studies; mean prevalence of 2.5%; range 0.8%–40%). In individuals with multilevel disc pathology the affected discs were most frequently adjacent. Overall, disc degeneration increased with age and findings were more frequently seen in the lower than the upper thoracic spine.

Conclusions:

Degenerative disc disease is the most prevalent form of degenerative thoracic spinal pathology in healthy individuals. It increases with age and occurs most frequently in the lower thoracic spine. However, data on degenerative spinal pathology in healthy individuals is currently sparse, limiting understanding of the natural history of symptomatic disease. We found significant heterogeneity between studies and inconsistent use of terminology; future work should include large-scale imaging studies of healthy individuals across broad populations and should seek to promote the use of standardised terminology by researchers and medical professionals.