Degenerative disc disease as a cause of back pain in the thalassaemic population: a case-control study using MRI and plain radiographs
- First Online:
- 168 Downloads
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.
KeywordsThalassemia Back pain Intervertebral disc Magnetic resonance imaging Diagnostic X-ray
- 1.Cotran RS, Kumar V, CT Robbins. Pathologic basis of disease. 6th ed. Pennsylvania: W. B. Saunders Company; 1999. p. 615. Chap 14Google Scholar
- 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
- 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
- 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