Diagnostic Neuroradiology

Neuroradiology

, Volume 56, Issue 1, pp 25-33

Disc degeneration and chronic low back pain: an association which becomes nonsignificant when endplate changes and disc contour are taken into account

  • Francisco M. KovacsAffiliated withDepartamento Científico, Fundación KovacsSpanish Back Pain Research Network, Fundación Kovacs
  • , Estanislao AranaAffiliated withSpanish Back Pain Research Network, Fundación KovacsServicio de Radiología, Fundación Instituto Valenciano de Oncología Email author 
  • , Ana RoyuelaAffiliated withCIBER Epidemiología y Salud Pública (CIBERESP)Unidad de Bioestadística Clínica, IRYCIS, Hospital Ramón y Cajal
  • , Ana EstremeraAffiliated withSpanish Back Pain Research Network, Fundación KovacsHospital Son Llàtzer
  • , Guillermo AmengualAffiliated withSpanish Back Pain Research Network, Fundación KovacsHospital Son Llàtzer
  • , Beatriz AsenjoAffiliated withSpanish Back Pain Research Network, Fundación KovacsHospital Carlos Haya
  • , Helena SarasíbarAffiliated withSpanish Back Pain Research Network, Fundación KovacsHospital Son Llàtzer
  • , Isabel GalarragaAffiliated withSpanish Back Pain Research Network, Fundación KovacsHospital de Manacor
  • , Ana AlonsoAffiliated withSpanish Back Pain Research Network, Fundación KovacsFundación Jiménez Díaz
    • , Carlos CasillasAffiliated withDepartamento Científico, Fundación KovacsSpanish Back Pain Research Network, Fundación KovacsInstituto de Traumatología Unión de Mutuas
    • , Alfonso MurielAffiliated withCIBER Epidemiología y Salud Pública (CIBERESP)Unidad de Bioestadística Clínica, IRYCIS, Hospital Ramón y Cajal
    • , Carmen MartínezAffiliated withSpanish Back Pain Research Network, Fundación KovacsHospital Son Llàtzer
    • , Víctor AbrairaAffiliated withCIBER Epidemiología y Salud Pública (CIBERESP)Unidad de Bioestadística Clínica, IRYCIS, Hospital Ramón y Cajal

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Abstract

Introduction

The objective of this study was to assess the association between severe disc degeneration (DD) and low back pain (LBP).

Methods

A case–control study was conducted with 304 subjects, aged 35–50, recruited in routine clinical practice across six hospitals; 240 cases (chronic LBP patients with a median pain duration of 46 months) and 64 controls (asymptomatic subjects without any lifetime history of significant LBP). The following variables were assessed once, using previously validated methods: gender, age, body mass index (BMI), lifetime smoking exposure, degree of physical activity, severity of LBP, disability, and findings on magnetic resonance (MRI) (disc degeneration, Modic changes (MC), disc protrusion/hernia, annular tears, spinal stenosis, and spondylolisthesis). Radiologists who interpreted MRI were blinded to the subjects' characteristics. A multivariate logistic regression model assessed the association between severe DD and chronic LBP, adjusting for gender, age, BMI, physical activity, MC, disc protrusion/hernia, and spinal stenosis.

Results

Severe DD at ≥1 level was found in 46.9 % of the controls and 65.8 % of the cases. Crude odds ratio (95 % CI), for suffering chronic LBP when having severe DD, was 2.06 (1.05; 4.06). After adjusting for “MC” and “disc protrusion/hernia,” it was 1.81 (0.81; 4.05).

Conclusions

The association between severe DD and LBP ceases to be significant when adjusted for MC and disc protrusion/hernia. These results do not support that DD as a major cause of chronic LBP.

Keywords

Low back pain Vertebral endplate changes Disk degeneration Magnetic resonance imaging Lumbar spine