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Anemia was associated with multilevel lumbar disc degeneration in patients with low back pain: a single-center retrospective study

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It has not been determined which factors were related to multilevel lumbar disc degeneration (MLDD). The objective of this study was to determine the prevalence of MLDD among symptomatic patients using the magnetic resonance imaging method. The study also aimed to clarify the associations between MLDD and suspected risk factors through a multivariate model.


A total of 530 young and middle-aged patients, suffered from low back pain were retrospectively assessed by 2 independent observers, who used sagittal T2-weighted MR imaging. Subjects were divided into two groups, MLDD group and non-MLDD group, according to the number of degenerated discs. Demographic and radiological data included age, gender, weight, height, body mass index, smoking status, alcohol drinking, lumbar lordosis, presence of hypertension (HT), diabetes mellitus and anemia.


There were 309 men and 221 women with an average age of 37.5  ±  8.5 years. In general, 37.7% of patients were diagnosed with disc degeneration (DD) at more than two levels. Triple level DD was the most common pattern and was more prevalent in women (<0.05). Using multivariate analyses, age (odds ratio [OR]: 1.14; 95% confidence interval [CI] 1.11–1.18; p <0.001), hypertension (OR: 2.67; 95% CI 1.38–5.16; p = 0.03) and anemia (OR: 3.84; 95% CI 2.03–7.28; <0.001) were significantly associated with MLDD.


Despite the young age of this cohort, MLDD is common among patients with low back pain. A significant independent association exists between age, HT, anemia and multilevel disc degeneration in the lumbar region.

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Availability of data and materials

Raw data would be made available on reasonable request and with the permission of the institution where the data were generated. Hengrui Chang was the person to be contacted if someone wants to request the data from this study.


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WYD designed the study; HRC and XDG searched relevant studies; HRC, XYL and RYZ analyzed and interpreted the data; HRC wrote the manuscript; and WYD approved the final version of the manuscript.

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Correspondence to Wenyuan Ding.

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Chang, H., Gao, X., Li, X. et al. Anemia was associated with multilevel lumbar disc degeneration in patients with low back pain: a single-center retrospective study. Eur Spine J 31, 1897–1905 (2022).

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