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Juvenile Discogenic Disease, Spine, 1994


 

This study published in the peer-reviewed journal "Spine" reported on 1,419 patients and introduced, for the first time, the existence and importance of genomic spine disorders.  Juvenile discogenic disease (JDD) was the particular genomic entity reported on because of its unique appearance on MRI studies.  Following the publication of this study it has become apparent that JDD is but one part of a genomic spine disorder spectrum.  It is now estimated, with better imaging and with better awareness on the part of clinicians, that as many as 50% of all  patients presenting with significant back complaints have an underlying genomic spine disorder.  Unless identified and effectively addressed by appropriate preventive programs those with these problems are at high risk for significant disability later in life.  It has been estimated, by some spine surgeons, that about 80% of patients coming to surgery (frequently multiple surgeries) have previously unrecognized and untreated underlying genomic disorders.  The Editor's experience confirms this observation.
Kenneth Heithoff, founder of the Center for Diagnostic Imaging in Minneapolis, was one of the first radiologists in the United States to apply CT and MRI imaging for the purpose of identifying genomic spine disorders.  Heithoff and his associates were the radiologic pioneers who first brought the awareness of disease entities such as JDD to the attention of the medical establishment.  

Heithoff, who has published numerous radiologic survey studies,  was one of the first to recognize that JDD, as a congenital abnormality of development, was frequently seen in association with other congenital abnormalities (the "Zebra Phenomenon" principle).  From his own studies Heithoff identified the following as "fellow travelers":

Scoliosis
Spondylolysis
Spondylolisthesis
Congenitally Small Spinal Canal
Congenital Poor Support 
Tropism of the Facet Joints
Asymmetrical Vertebrae 
Spina Bifida
Conjoined Nerve Roots

These associations continue to be made along with other important radiologic clues allowing the diagnosis of genomic spine disorders to become more refined.
 
In 1997 Heithoff's associates noted that "Early recognition with prompt institution of conservative therapy and vocational counseling may be important in these patients to avoid, or at least delay, the complications of degenerative disc disease" (Gundry C, Fritts H: Juvenile Discogenic Disease, Clin. Ortho. Rel. Res., Number 343, 1997).