Disc degeneration and chronic low back pain: an association which becomes nonsignificant when endplate changes and disc contour are taken into account
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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.
KeywordsLow back pain Vertebral endplate changes Disk degeneration Magnetic resonance imaging Lumbar spine
Body mass index
Low back pain
Visual analog scale
- 4.Wilmink JT (2010) Pathologic anatomy and mechanisms of nerve root compression. In: Lumbar spinal imaging in radicular pain and related conditions: Understanding diagnostic images in a clinical context. Springer-Verlag Berlin-Heidelberg, pp 59–111Google Scholar
- 5.Spine Surgery Societies, Blue Cross Blue Shield of North Carolina Lumbar Spine (2010) Fusion surgery “notification.” www.spine.org/Documents/BCBSNC_Lumbar_Fusion_Response121510.pdf. Accessed 30 June 2013
- 13.Merskey HB, Bogduk N (1994) Detailed descriptions of pain syndromes. In: Merskey HB, Bogduk N (eds) Classification of chronic pain. IASP, Seattle, pp 39–58Google Scholar
- 26.Belsley DA (1991) Conditioning diagnostics: collinearity and weak data in regression. Wiley, New YorkGoogle Scholar
- 30.Borenstein DG, O'Mara JW Jr, Boden SD et al (2001) The value of magnetic resonance imaging of the lumbar spine to predict low-back pain in asymptomatic subjects: a seven-year follow-up study. J Bone Joint Surg Am 83A:1306–1311Google Scholar
- 34.Moix J, Kovacs FM, Martín A et al (2011) Catastrophizing, state-anxiety, anger and depressive symptoms do not correlate with disability when variations of trait-anxiety are taken into account. A study of chronic low back pain patients treated in Spanish pain units [NCT00360802]. Pain Med 12:1008–1017PubMedCrossRefGoogle Scholar