Serial MRI over 20 years supports a staged sequence of cervical degenerative findings in asymptomatic volunteers

Magnetic resonance imaging findings of cervical degeneration are common in asymptomatic adults, but whether these findings follow a predictable sequence is unclear. We analyzed serial cervical MRI data from 131 asymptomatic volunteers examined at baseline, 10 years, and 20 years. At the disc level, we modeled trajectories of decreased signal intensity (DSI), anterior compression (AC), posterior disc protrusion (PDP), disc-space narrowing (DSN), and foraminal stenosis (FS). DSI trajectories showed a graded association with later AC and PDP at both follow-up intervals. Compared with discs that remained DSI-negative, persistent DSI was associated with approximately threefold higher risks of AC and PDP at 10 years and fivefold higher risks at 20 years. Among discs with baseline DSI, persistent AC/PDP identified discs at highest risk of later FS, whereas associations with DSN were weaker. Pairwise analyses showed that AC and PDP usually appeared within the same decade, whereas FS more often preceded DSN among late structural findings. These results support a staged pattern of cervical degenerative MRI findings in which DSI was associated with later AC/PDP and persistent AC/PDP identified a higher-risk pathway toward FS. This framework may improve interpretation of incidental cervical MRI findings.