Neuroradiology

, 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 Arana
  • Ana Royuela
  • Ana Estremera
  • Guillermo Amengual
  • Beatriz Asenjo
  • Helena Sarasíbar
  • Isabel Galarraga
  • Ana Alonso
  • Carlos Casillas
  • Alfonso Muriel
  • Carmen Martínez
  • Víctor Abraira
Diagnostic Neuroradiology

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 

Abbreviations

BMI

Body mass index

DD

Disc degeneration

LBP

Low back pain

P25

25th percentile

P75

75th percentile

RMQ

Roland–Morris Questionnaire

VAS

Visual analog scale

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
  • 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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