, Volume 56, Issue 1, pp 25–33 | Cite as

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

  • Francisco M. Kovacs
  • Estanislao AranaEmail author
  • Ana Royuela
  • Ana Estremera
  • Guillermo Amengual
  • Beatriz Asenjo
  • Helena Sarasíbar
  • Isabel Galarraga
  • Ana Alonso
  • Carlos Casillas
  • Alfonso Muriel
  • Carmen Martínez
  • Víctor Abraira
Diagnostic Neuroradiology



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.


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



Body mass index


Disc degeneration


Low back pain


25th percentile


75th percentile


Roland–Morris Questionnaire


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.

Supplementary material

234_2013_1294_MOESM1_ESM.docx (14 kb)
Supplementary Table (DOCX 13 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Francisco M. Kovacs
    • 1
    • 2
  • Estanislao Arana
    • 2
    • 3
    Email author
  • Ana Royuela
    • 4
    • 5
  • Ana Estremera
    • 2
    • 6
  • Guillermo Amengual
    • 2
    • 6
  • Beatriz Asenjo
    • 2
    • 7
  • Helena Sarasíbar
    • 2
    • 6
  • Isabel Galarraga
    • 2
    • 8
  • Ana Alonso
    • 2
    • 9
  • Carlos Casillas
    • 2
    • 10
  • Alfonso Muriel
    • 5
    • 4
  • Carmen Martínez
    • 2
    • 6
  • Víctor Abraira
    • 5
    • 4
  1. 1.Departamento CientíficoFundación KovacsPalma de MallorcaSpain
  2. 2.Spanish Back Pain Research NetworkFundación KovacsPalma de MallorcaSpain
  3. 3.Servicio de RadiologíaFundación Instituto Valenciano de OncologíaValenciaSpain
  4. 4.CIBER Epidemiología y Salud Pública (CIBERESP)MadridSpain
  5. 5.Unidad de Bioestadística Clínica, IRYCISHospital Ramón y CajalMadridSpain
  6. 6.Hospital Son LlàtzerPalma de MallorcaSpain
  7. 7.Hospital Carlos HayaMálagaSpain
  8. 8.Hospital de ManacorManacorSpain
  9. 9.Fundación Jiménez DíazMadridSpain
  10. 10.Instituto de Traumatología Unión de MutuasCastellónSpain

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