Skeletal Radiology

, Volume 35, Issue 2, pp 95–102 | Cite as

Degenerative disc disease as a cause of back pain in the thalassaemic population: a case-control study using MRI and plain radiographs

  • S. Desigan
  • M. A. Hall-Craggs
  • C-P. Ho
  • J. Eliahoo
  • J. B. Porter
Scientific Article



The aim of this study was to test our observation that back pain in thalassemic patients could be caused by premature and extensive lumbar degenerative disc disease, when compared to non-thalassemic patients with back pain.

Methods and materials

Sixteen thalassemic patients with their sex- and age-matched controls were recruited into the study, 12 with thalassemia major, and 4 with thalassemia intermedia. Both the thalassemia patients and control subjects suffered from back pain, which was subjective rather than measured/pain scored. All subjects underwent magnetic resonance (MR) imaging of the lumbar spine, and 11 of the cases and 8 controls had lumbar spine radiographs. Each lumbar disc was scored for radiographic appearances and MR features of disc degeneration and disc protrusion. Proportion values for these parameters and median scores were derived at each disc level, and were analyzed and compared.


There was a statistically-significant difference between proportion values of cases and controls for the MR features (P value=0.01, n=16) and the radiographic features (P value=0.01, n=11 cases, n=8 controls) of disc degeneration. The median disc level scores for the thalassemic group were uniformly high across all lumbar discs, and at all levels except at L 4/5. The control group conversely demonstrated a predilection for disc degeneration at L4/5 level.


The distribution of lumbar disc degeneration in thalassemic patients with back pain is more extensive, severe and multi-level in nature compared to matched controls, and disc degeneration should be considered as a significant cause of back pain in this population group.


Thalassemia Back pain Intervertebral disc Magnetic resonance imaging Diagnostic X-ray 


  1. 1.
    Cotran RS, Kumar V, CT Robbins. Pathologic basis of disease. 6th ed. Pennsylvania: W. B. Saunders Company; 1999. p. 615. Chap 14Google Scholar
  2. 2.
    Angastiniotis M, Pavlides N, Aristidou K et al. Bone pain in thalassaemia: assessment of DEXA and MRI findings. J Pediatr Endocrinol Metab 1998;11:779–84PubMedGoogle Scholar
  3. 3.
    Papavasiliou C, Gouliamos A, Vlahos L, Trakadas S, Kalovidouris A, Pouliades GR. CT and MRI of symptomatic spinal involvement by extramedullary haemopoiesis. Clin Radiol 1990;42:91–2PubMedCrossRefGoogle Scholar
  4. 4.
    Aydingőz Ű, Oto A, Cila A. Spinal cord compression due to epidural extramedullary haematopoiesis in thalassaemia: MRI. Neuroradiology 1997;39 12:870–2PubMedCrossRefGoogle Scholar
  5. 5.
    Dimitris A, Papanastasiou, Baikousis A, Sdougos G, Ziambaras T, Korovesis P. Correlative analysis of the sagittal profile of the spine in patients with β-thalassemia and in healthy persons. J Spinal Disord 2000;13:113–7CrossRefGoogle Scholar
  6. 6.
    Brill PW, Winchester P, Giardina PJ, Cunningham-Rundles S. Deferoxamine-induced bone dysplasia in patients with Thalassemia major. Am J Roentgenol 1991;156:561–5Google Scholar
  7. 7.
    Onur Ősivri A, Gűmrűk F, Altay Ç. Beta thalassaemia: a report of 20 children. Clin Rheumatol 1999;18:42–4CrossRefGoogle Scholar
  8. 8.
    Mahachoklertwattana P, Chuansumrit A, Sirisriro R, Choubtum L, Sriphrapradang A, Rajatanavin R. Bone mineral density, biochemical and hormonal profiles in suboptimally treated children and adolescents with beta-thalassaemia disease. Clin Endocrinol (Oxf) 2003;58 3:273–9CrossRefGoogle Scholar
  9. 9.
    Abdollah Shamshirsaz A, Bekheirnia MR, Kamgar M, Pourzahedgila Bouzari N, Habibzadeh M, Hashemi R, Abdollah Shamshirsaz AH, Aghakhani S, Homayoun H, Larijani B. Metabolic and endocrinologic complications in beta-thalassemia major: a multicenter study in Tehran. BMC Endocr Disord 2003;3 1:4CrossRefGoogle Scholar
  10. 10.
    Wonke B, Jensen C, Hanslip JJ, Prescott E, Lalloz M, Layton M, Ert, Tuck S, Agnew JE, Raja K, Davies K, Hoffbrand AV. Genetic and acquired predisposing factors and treatment of osteoporosis in thalassaemia major. J Pediatr Endocrinol Metab 1998;11 Suppl 3:795–801PubMedGoogle Scholar
  11. 11.
    Grinberg LN, Rachmilewitz EA, Kitrossky N, Chevion M. Hydroxyl radical generation in B-Thalassemic red blood cells. Free Radic Biol Med 1995;18 3:611–5PubMedCrossRefGoogle Scholar
  12. 12.
    Yamaza T, Masuda KF, Atsuta I, Nishijima K, Kido MA, Tanaka T. Oxidative stress-induced DNA change in the synovial cells of temporomandibular joint in the rat. J Dent Res 2004;83 8:619–24PubMedCrossRefGoogle Scholar
  13. 13.
    Rey J, Gagliano R, Christides C, Pillard E, Magnan F, Tourniaire P, Arwidson I, Raymond-Gelle MC, Boulat O, Arlaud J. Spinal cord compression caused by extramedullary hematopoiesis foci in the course of thalassemia. Presse Med 2001;30 27:1351–3PubMedGoogle Scholar
  14. 14.
    Tan TC, Tsao J, Cheung FC. Extramedullary haemopoiesis in thalassemia intermedia presenting as paraplegia. J Clin Neurosci 2002;9 6:721–5PubMedCrossRefGoogle Scholar
  15. 15.
    Chourmouzi D, Pistevou-Gompaki K, Plataniotis G, Skaragas G, Papadopoulos L, Drevelegas A. MRI findings of extramedullary haemopoiesis. Eur Radiol 2001;11 9:1803–6PubMedCrossRefGoogle Scholar
  16. 16.
    Chan YL, Li CK, Pang LM, Chik KW. Desferrioxamine-induced long bone changes in thalassaemic patients—radiographic features, prevalence and relations with growth. Clin Radiol 2000;55 8:610–4PubMedCrossRefGoogle Scholar
  17. 17.
    Hartkamp MJ, Babyn PS, Oliveri F. Spinal deformities in deferoxamine-treated homozygous beta-thalassemia major patients. Pediatr Radiol 1993;23:525–8PubMedCrossRefGoogle Scholar
  18. 18.
    Naselli A, Vignolo M, Di Battista E, et al. Long term follow up of skeletal dysplasia in thalassaemia major. J Pediatr Endocrinol Metab 1998;11:817–25PubMedGoogle Scholar
  19. 19.
    Levin TL, Sheth S, Berdon WE, Ruzal-Shapiro C, Piomelli S. Deferoxamine-induced platyspondyly in hypertransfused thalassemic patients. Pediatr Radiol 1995;25:S122–4PubMedGoogle Scholar
  20. 20.
    Levin TL, Sheth S, Ruzal-Shapiro C, Abramson S, Piomelli S, Berdon WE. MRI marrow observations in thalassemia: the effects of the primary disease, transfusional therapy, and chelation. Pediatr Radiol 1995;25:607–13PubMedCrossRefGoogle Scholar
  21. 21.
    Tunaci M, Tunaci A, Engin G, et al. Imaging features of Thalassemia. Eur Radiol 1999;9:1804–9PubMedCrossRefGoogle Scholar
  22. 22.
    De Virgiliis S, Congia M, Frau F, et al. Deferoxamine-induced growth retardation in patients with thalassemia major. J Pediatr 1988;113:661–9PubMedCrossRefGoogle Scholar
  23. 23.
    Whalen JL, Parke WW, Mazur JM, Stauffer ES. The intrinsic vasculature of developing vertebral end plates and its nutritive significance to the intervertebral discs. J Pediatr Orthop 1985;5 4:403–10PubMedGoogle Scholar
  24. 24.
    Rajasekaran S, Babu JN, Arun R, Armstrong BR, Shetty AP, Murugan S. ISSLS prize winner: a study of diffusion in human lumbar discs: a serial magnetic resonance imaging study documenting the influence of the endplate on diffusion in normal and degenerate discs. Spine 2004;29 23:2654–67PubMedCrossRefGoogle Scholar
  25. 25.
    Benneker LM, Heini PF, Alini M, Anderson SE, Ito K. 2004 Young investigator award winner: vertebral endplate marrow contact channel occlusions and intervertebral disc degeneration. Spine 2005;30 2:167–73PubMedCrossRefGoogle Scholar
  26. 26.
    Hall-Craggs MA, Porter J, Gatehouse PD, Bydder GM. Ultrashort echo time (UTE) MRI of the spine in thalassaemia. Br J Radiol 2004;77:104–10PubMedCrossRefGoogle Scholar

Copyright information

© ISS 2005

Authors and Affiliations

  • S. Desigan
    • 1
  • M. A. Hall-Craggs
    • 1
  • C-P. Ho
    • 1
  • J. Eliahoo
    • 2
  • J. B. Porter
    • 3
  1. 1.Department of Imaging, University College London Hospitals NHS Foundation TrustLondonUK
  2. 2.Research and Development DirectorateUniversity College London Hospitals NHS TrustLondonUK
  3. 3.Department of Haematology, University College London Hospitals NHS TrustUniversity College HospitalLondonUK

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