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Infrarenal aortic diameter, aortoiliac bifurcation level and lumbar disc degenerative changes: a cross-sectional MR study

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Abstract

Purpose

To examine a possible correlation of infrarenal aortic diameter and aortoiliac bifurcation level with lumbar disc degenerative changes.

Methods

This was a cross-sectional, single-center retrospective study on lumbar magnetic resonance images of patients with low back pain (n = 496). Lumbar disc degenerative changes were reported on the basis of the Pfirrmann grading system and accordingly, patients were grouped as with grade I–II findings (n = 192), with grade III findings (n = 64) and with grade IV–V findings (n = 240). The groups were matched for sex, body mass index and the history of diabetes mellitus, hypertension, hyperlipidemia and smoking. Infrarenal aortic diameter and aortoiliac bifurcation level were compared between the three groups.

Results

Pairwise comparisons between the three groups of patients with Pfirrmann grades of I–II, III and IV–V revealed significant differences (p < 0.05) in terms of the median infrarenal aortic diameter (17 mm [interquartile range 4], 18 mm [4] and 19 mm [4], respectively) and the median aortoiliac bifurcation level (3 [2], 4 [2] and 5 [3], respectively; the higher the value, the more the caudal displacement). These associations were independent of conventional risk factors of atherosclerosis (including age) and from each other.

Conclusions

This study showed a significant, direct correlation of the infrarenal aortic diameter and the level of aortoiliac bifurcation with lumbar intervertebral degenerative changes according to the Pfirrmann grading system. The associations were independent of well-known risk factors of atherosclerosis and from each other.

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References

  1. Pye SR, Reid DM, Lunt M, Adams JE, Silman AJ, O’Neill TW (2007) Lumbar disc degeneration: association between osteophytes, end-plate sclerosis and disc space narrowing. Ann Rheum Dis 66(3):330–333. https://doi.org/10.1136/ard.2006.052522

    Article  PubMed  Google Scholar 

  2. Taher F, Essig D, Lebl DR, Hughes AP, Sama AA, Cammisa FP, Girardi FP (2012) Lumbar degenerative disc disease: current and future concepts of diagnosis and management. Adv Orthop 2012:970752. https://doi.org/10.1155/2012/970752

    Article  PubMed  PubMed Central  Google Scholar 

  3. Sowa G, Vadala G, Studer R, Kompel J, Iucu C, Georgescu H, Gilbertson L, Kang J (2008) Characterization of intervertebral disc aging: longitudinal analysis of a rabbit model by magnetic resonance imaging, histology, and gene expression. Spine 33(17):1821–1828. https://doi.org/10.1097/BRS.0b013e31817e2ce3

    Article  PubMed  Google Scholar 

  4. Hanaei S, Abdollahzade S, Khoshnevisan A, Kepler CK, Rezaei N (2015) Genetic aspects of intervertebral disc degeneration. Rev Neurosci 26(5):581–606. https://doi.org/10.1515/revneuro-2014-0077

    Article  CAS  PubMed  Google Scholar 

  5. Williams FM, Sambrook PN (2011) Neck and back pain and intervertebral disc degeneration: role of occupational factors. Best Pract Res Clin Rheumatol 25(1):69–79. https://doi.org/10.1016/j.berh.2011.01.007

    Article  CAS  PubMed  Google Scholar 

  6. Suri P, Katz JN, Rainville J, Kalichman L, Guermazi A, Hunter DJ (2010) Vascular disease is associated with facet joint osteoarthritis. Osteoarthr Cartil/OARS Osteoarthr Res Soc 18(9):1127–1132. https://doi.org/10.1016/j.joca.2010.06.012

    Article  CAS  Google Scholar 

  7. From the Centers for Disease Control and Prevention (2001) Prevalence of disabilities and associated health conditions among adults—United States, 1999. JAMA 285(12):1571–1572

    Google Scholar 

  8. Suri P, Hunter DJ, Rainville J, Guermazi A, Katz JN (2012) Quantitative assessment of abdominal aortic calcification and associations with lumbar intervertebral disc height loss: the Framingham study. Spine J 12(4):315–323. https://doi.org/10.1016/j.spinee.2012.03.033

    Article  PubMed  PubMed Central  Google Scholar 

  9. Kauppila LI, McAlindon T, Evans S, Wilson PW, Kiel D, Felson DT (1997) Disc degeneration/back pain and calcification of the abdominal aorta. A 25-year follow-up study in Framingham. Spine 22(14):1642–1647 (discussion 1648–1649)

    Article  CAS  PubMed  Google Scholar 

  10. Forbang NI, Ix JH, Allison MA, Criqui MH (2015) Associations of cardiovascular disease risk factors and calcified atherosclerosis with aortoiliac bifurcation position: the multiethnic study of atherosclerosis. Angiology 66(1):90–95. https://doi.org/10.1177/0003319713516669

    Article  PubMed  Google Scholar 

  11. Rehm JP, Grange JJ, Baxter BT (1998) The formation of aneurysms. Semin Vasc Surg 11(3):193–202

    CAS  PubMed  Google Scholar 

  12. Reynolds HR, Tunick PA, Kort S, Rosenzweig BP, Freedberg RS, Katz ES, Applebaum RM, Portnay EL, Adelman MA, Attubato MJ, Kronzon I (2001) Abdominal aortic aneurysms and thoracic aortic atheromas. J Am Soc Echocardiogr 14(11):1127–1131

    Article  CAS  PubMed  Google Scholar 

  13. Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N (2001) Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine 26(17):1873–1878

    Article  CAS  PubMed  Google Scholar 

  14. Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1(8476):307–310

    Article  CAS  PubMed  Google Scholar 

  15. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ, Joint National Committee on Prevention DE, Treatment of High Blood Pressure. National Heart L, Blood I, National High Blood Pressure Education Program Coordinating C (2003) Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 42(6):1206–1252. https://doi.org/10.1161/01.HYP.0000107251.49515.c2

    Article  CAS  PubMed  Google Scholar 

  16. Roden M (2016) Diabetes mellitus: definition, classification and diagnosis. Wien Klin Wochenschr 128(Suppl 2):37–40. https://doi.org/10.1007/s00508-015-0931-3

    Article  CAS  Google Scholar 

  17. Expert Panel on Detection E, Treatment of High Blood Cholesterol in A (2001) Executive summary of the third report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 285(19):2486–2497

    Article  Google Scholar 

  18. Rajasekaran S, Tangavel C, Aiyer SN, Nayagam SM, Raveendran M, Demonte NL, Subbaiah P, Kanna R, Shetty AP, Dharmalingam K (2017) ISSLS PRIZE IN CLINICAL SCIENCE 2017: Is infection the possible initiator of disc disease? An insight from proteomic analysis. Eur Spine J 26(5):1384–1400. https://doi.org/10.1007/s00586-017-4972-3

    Article  CAS  PubMed  Google Scholar 

  19. Chen K, Lv X, Li W, Yu F, Lin J, Ma J, Xiao D (2017) Autophagy is a protective response to the oxidative damage to endplate chondrocytes in intervertebral disc: implications for the treatment of degenerative lumbar disc. Oxid Med Cell Longev 2017:4041768. https://doi.org/10.1155/2017/4041768

    PubMed  PubMed Central  Google Scholar 

  20. Chen B, Liu Y, Zhang Y, Li J, Cheng K, Cheng L (2017) IL-21 Is positively associated with intervertebral disc degeneration by interaction with TNF-alpha through the JAK-STAT signaling pathway. Inflammation 40(2):612–622. https://doi.org/10.1007/s10753-017-0508-6

    Article  CAS  PubMed  Google Scholar 

  21. Kauppila LI, Tallroth K (1993) Postmortem angiographic findings for arteries supplying the lumbar spine: their relationship to low-back symptoms. J Spinal Disord 6(2):124–129

    Article  CAS  PubMed  Google Scholar 

  22. de Schepper EI, Damen J, van Meurs JB, Ginai AZ, Popham M, Hofman A, Koes BW, Bierma-Zeinstra SM (2010) The association between lumbar disc degeneration and low back pain: the influence of age, gender, and individual radiographic features. Spine 35(5):531–536. https://doi.org/10.1097/BRS.0b013e3181aa5b33

    Article  PubMed  Google Scholar 

  23. Tokuda O, Okada M, Fujita T, Matsunaga N (2007) Correlation between diffusion in lumbar intervertebral disks and lumbar artery status: evaluation with fresh blood imaging technique. J Magn Reson Imaging: JMRI 25(1):185–191. https://doi.org/10.1002/jmri.20785

    Article  PubMed  Google Scholar 

  24. Kauppila LI (1997) Prevalence of stenotic changes in arteries supplying the lumbar spine. A postmortem angiographic study on 140 subjects. Ann Rheum Dis 56(10):591–595

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Turgut AT, Sonmez I, Cakit BD, Kosar P, Kosar U (2008) Pineal gland calcification, lumbar intervertebral disc degeneration and abdominal aorta calcifying atherosclerosis correlate in low back pain subjects: a cross-sectional observational CT study. Pathophysiology 15(1):31–39. https://doi.org/10.1016/j.pathophys.2007.12.001

    Article  CAS  PubMed  Google Scholar 

  26. Hadjipavlou AG, Tzermiadianos MN, Bogduk N, Zindrick MR (2008) The pathophysiology of disc degeneration: a critical review. J Bone Jt Surg Br 90(10):1261–1270. https://doi.org/10.1302/0301-620X.90B10.20910

    Article  CAS  Google Scholar 

  27. Karasik D, Kiel DP, Kiely DK, Cupples LA, Wilson PW, O’Donnell CJ, Felson DT (2006) Abdominal aortic calcification and exostoses at the hand and lumbar spine: the Framingham study. Calcif Tissue Int 78(1):1–8. https://doi.org/10.1007/s00223-005-0054-3

    Article  CAS  PubMed  Google Scholar 

  28. Laughlin GA, Allison MA, Jensky NE, Aboyans V, Wong ND, Detrano R, Criqui MH (2011) Abdominal aortic diameter and vascular atherosclerosis: the multi-ethnic study of atherosclerosis. Eur J Vasc Endovasc Surg 41(4):481–487. https://doi.org/10.1016/j.ejvs.2010.12.015

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Kauppila LI (2009) Atherosclerosis and disc degeneration/low-back pain—a systematic review. Eur J Vasc Endovasc Surg 37(6):661–670. https://doi.org/10.1016/j.ejvs.2009.02.006

    Article  CAS  PubMed  Google Scholar 

  30. Forbang NI, Nguyen T, Ix JH, Criqui MH, Allison MA (2011) The downward shift of the aortic bifurcation, a possible marker for vascular aging. J Surg Radiol 2:372–377

    PubMed  PubMed Central  Google Scholar 

  31. Golledge J, Muller J, Daugherty A, Norman P (2006) Abdominal aortic aneurysm: pathogenesis and implications for management. Arterioscler Thromb Vasc Biol 26(12):2605–2613. https://doi.org/10.1161/01.ATV.0000245819.32762.cb

    Article  CAS  PubMed  Google Scholar 

  32. Iribarren C, Darbinian JA, Go AS, Fireman BH, Lee CD, Grey DP (2007) Traditional and novel risk factors for clinically diagnosed abdominal aortic aneurysm: the Kaiser multiphasic health checkup cohort study. Ann Epidemiol 17(9):669–678. https://doi.org/10.1016/j.annepidem.2007.02.004

    Article  PubMed  Google Scholar 

  33. Kauppila LI, Penttila A, Karhunen PJ, Lalu K, Hannikainen P (1994) Lumbar disc degeneration and atherosclerosis of the abdominal aorta. Spine 19(8):923–929

    Article  CAS  PubMed  Google Scholar 

  34. Prado CM, Rossi MA (2006) Circumferential wall tension due to hypertension plays a pivotal role in aorta remodelling. Int J Exp Pathol 87(6):425–436. https://doi.org/10.1111/j.1365-2613.2006.00506.x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Kauppila LI (1994) Blood supply of the lower thoracic and lumbosacral regions. Postmortem aortography in 38 young adults. Acta Radiol 35(6):541–544

    Article  CAS  PubMed  Google Scholar 

  36. Hangai M, Kaneoka K, Kuno S, Hinotsu S, Sakane M, Mamizuka N, Sakai S, Ochiai N (2008) Factors associated with lumbar intervertebral disc degeneration in the elderly. Spine J 8(5):732–740. https://doi.org/10.1016/j.spinee.2007.07.392

    Article  PubMed  Google Scholar 

  37. Kim NS, Kang SH, Park SY (2013) Coexistence of expanding abdominal aortic aneurysm and aggravated intervertebral disc extrusion—a case report. Korean J Anesthesiol 65(4):345–348. https://doi.org/10.4097/kjae.2013.65.4.345

    Article  PubMed  PubMed Central  Google Scholar 

  38. de Boer NJ, Knaap SF, de Zoete A (2010) Clinical detection of abdominal aortic aneurysm in a 74-year-old man in chiropractic practice. J Chiropract Med 9(1):38–41. https://doi.org/10.1016/j.jcm.2009.12.002

    Article  Google Scholar 

  39. Kjaer P, Leboeuf-Yde C, Korsholm L, Sorensen JS, Bendix T (2005) Magnetic resonance imaging and low back pain in adults: a diagnostic imaging study of 40-year-old men and women. Spine 30(10):1173–1180

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Radiology, Imam Reza Teaching Hospital, Tabriz University of Medical Sciences, Tabriz, Iran

    Abolhassan Shakeri & Mohammadreza Ojaghzadeh Behrooz

  2. Department of Neurosurgery, Imam Reza Teaching Hospital, Tabriz University of Medical Sciences, Tabriz, Iran

    Moslem Shakeri

  3. Department of Radiology, Zabol University of Medical Sciences, Zabol, Iran

    Razieh Behzadmehr

  4. Department of Anesthesiology, Imam Reza Teaching Hospital, Tabriz University of Medical Sciences, Tabriz, Iran

    Zohreh Ostadi

  5. Neurosciences Research Center, Tabriz University of Medical Sciences, Golgasht Street, Tabriz, Iran

    Daniel Fadaei Fouladi

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  1. Abolhassan Shakeri
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Correspondence to Daniel Fadaei Fouladi.

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Shakeri, A., Shakeri, M., Ojaghzadeh Behrooz, M. et al. Infrarenal aortic diameter, aortoiliac bifurcation level and lumbar disc degenerative changes: a cross-sectional MR study. Eur Spine J 27, 1096–1104 (2018). https://doi.org/10.1007/s00586-017-5388-9

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  • DOI: https://doi.org/10.1007/s00586-017-5388-9

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