Disc degeneration and chronic low back pain: an association which becomes nonsignificant when endplate changes and disc contour are taken into account
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The objective of this study was to assess the association between severe disc degeneration (DD) and low back pain (LBP).
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.
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).
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.
KeywordsLow back pain Vertebral endplate changes Disk degeneration Magnetic resonance imaging Lumbar spine
Body mass index
Low back pain
Visual analog scale
This study was funded by The Kovacs Foundation, a not-for-profit institution specializing in back pain research, with no links to the health industry. The Kovacs Foundation was not involved in the design and conduction of the study, data collection, management, analysis and interpretation of the data, preparation, review and approval of the manuscript, or in the decision to submit the article for publication.
Conflict of interest
We declare that we have no conflict of interest.
- 4.Wilmink JT (2010) Pathologic anatomy and mechanisms of nerve root compression. In: Lumbar spinal imaging in radicular pain and related conditions: Understanding diagnostic images in a clinical context. Springer-Verlag Berlin-Heidelberg, pp 59–111Google Scholar
- 5.Spine Surgery Societies, Blue Cross Blue Shield of North Carolina Lumbar Spine (2010) Fusion surgery “notification.” www.spine.org/Documents/BCBSNC_Lumbar_Fusion_Response121510.pdf. Accessed 30 June 2013
- 13.Merskey HB, Bogduk N (1994) Detailed descriptions of pain syndromes. In: Merskey HB, Bogduk N (eds) Classification of chronic pain. IASP, Seattle, pp 39–58Google Scholar
- 26.Belsley DA (1991) Conditioning diagnostics: collinearity and weak data in regression. Wiley, New YorkGoogle Scholar
- 30.Borenstein DG, O'Mara JW Jr, Boden SD et al (2001) The value of magnetic resonance imaging of the lumbar spine to predict low-back pain in asymptomatic subjects: a seven-year follow-up study. J Bone Joint Surg Am 83A:1306–1311Google Scholar
- 34.Moix J, Kovacs FM, Martín A et al (2011) Catastrophizing, state-anxiety, anger and depressive symptoms do not correlate with disability when variations of trait-anxiety are taken into account. A study of chronic low back pain patients treated in Spanish pain units [NCT00360802]. Pain Med 12:1008–1017PubMedCrossRefGoogle Scholar