European Spine Journal

, Volume 25, Issue 1, pp 2–13 | Cite as

Age and pro-inflammatory gene polymorphisms influence adjacent segment disc degeneration more than fusion does in patients treated for chronic low back pain

  • Ahmad OmairEmail author
  • Anne F. Mannion
  • Marit Holden
  • Gunnar Leivseth
  • Jeremy Fairbank
  • Olle Hägg
  • Peter Fritzell
  • Jens I. Brox
Original Article



Does lumbar fusion lead to accelerated adjacent segment disc degeneration (ASDD) or is it explained by genetics and aging? The influence of genetics on ASDD remains to be explored. This study assesses whether the disc space height adjacent to a fused segment is associated with candidate gene single nucleotide polymorphisms (SNPs).


Patients with low back pain from four RCTs (N = 208 fusion; 77 non-operative treatment) underwent standing plain radiography and genetic analyses at 13 ± 4 years follow-up. Disc space height was measured using a validated computer-assisted distortion-compensated roentgen analysis technique and reported in standard deviations from normal values. Genetic association analyses included 34 SNPs in 25 structural, inflammatory, matrix degrading, apoptotic, vitamin D receptor and OA-related genes relevant to disc degeneration. These were analysed for their association with disc space height (after adjusting for age, gender, smoking, duration of follow-up and treatment group) first, separately, and then together in a stepwise multivariable model.


Two SNPs from the IL18RAP gene (rs1420106 and rs917997) were each associated with a lower disc space height at the adjacent level (B = −0.34, p = 0.04 and B = −0.35, p = 0.04, respectively) and the MMP-9 gene SNP rs20544 was associated with a greater disc space height (B = 0.35, p = 0.04). Age (p < 0.001) and fusion (p < 0.008) were also significant variables in each analysis. The total explained variance in disc space height was for each SNP model 13–14 %, with 11–12 % of this being accounted for by the given SNP, 64–67 % by age and 19–22 % by fusion. In the multivariable regression analysis (with nine SNPs selected for entry, along with the covariates) the total explained variance in disc space height was 23 %, with the nine SNPs, age and fusion accounting for 45, 45 and 7 % of this, respectively.


Age was the most significant determinant of adjacent segment disc space height followed by genetic factors, specifically inflammatory genes. Fusion explained a statistically significant but small proportion of the total variance. Much of the variance remained to be explained.


Chronic low back pain Adjacent segment disc degeneration Lumbar fusion Single nucleotide polymorphism Inflammatory genes 



We thank department of Immunology Oslo University Hospital-Rikshospitalet (IMMI), for providing us with the logistics for DNA purification and the Center for Interactive Genetics, Norwegian University of Life Sciences (UMB) Aas, for performing Sequenom analysis.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


AO Spine funds were received via the Hansjorg Wyss Research Award. In the UK, the study was also supported by Thames Valley Comprehensive Local Research Network for National Institutes for Health Research. In Norway, the Norwegian Research Council grant funds were received to support this work. We thank them for providing the financial support.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Ahmad Omair
    • 1
    • 9
    Email author
  • Anne F. Mannion
    • 2
  • Marit Holden
    • 3
  • Gunnar Leivseth
    • 4
  • Jeremy Fairbank
    • 5
  • Olle Hägg
    • 6
  • Peter Fritzell
    • 7
  • Jens I. Brox
    • 8
  1. 1.Department of OrthopaedicsOslo University Hospital-RikshospitaletOsloNorway
  2. 2.Department of Research and Development, Spine Center DivisionSchulthess KlinikZurichSwitzerland
  3. 3.Norwegian Computing CentreOsloNorway
  4. 4.Institute of Clinical Medicine, Neuromuscular Disorders Research GroupUiT the Arctic University of NorwayTromsøNorway
  5. 5.Nuffield Orthopaedic CentreUniversity of OxfordOxfordUK
  6. 6.Spine Center GöteborgGothenburgSweden
  7. 7.Neuro-Orthopedic CenterLänssjukhuset RyhovJönköpingSweden
  8. 8.Department of Physical Medicine and Rehabilitation, Oslo University HospitalUniversity of OsloOsloNorway
  9. 9.Department of Pathology, Shifa College of MedicineShifa Tameer e Millat UniversityIslamabadPakistan

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