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Association between anemia and lumbar disc degeneration in patients with low back pain: an observational retrospective study

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Abstract

Objective

The goal of this study was to evaluate the possible associations between anemia and morphologic features of lumbar disc degeneration (LDD) in subjects with low back pain.

Materials and methods

A total of 131 patients with normocytic or microcytic anemia (mean age 41.0 ± 6.4 yrs, BMI: 24.8 ± 3.3 kg/m2, 12.2% men) and a matched control group of 131 patients without anemia (mean age 41.0 ± 6.4 yrs, BMI: 24.9 ± 3.1 kg/m2, 12.2% men) were evaluated for LDD according to the Pfirrmann scoring system. The primary outcome was the difference of radiological features of LDD between two groups. The second outcome was the correlation between the hemoglobin (Hb) value and disc degeneration (DD). Statistical associations were assessed by Student's t-test, Chi-square test, and Spearman correlation.

Results

Anemic patients had a significantly higher number of degenerated discs than non-anemic patients in the level of L2/3 and L3/4 (p < 0.05). We also found that the severe DD occurred more frequently in the level of L2/3, L3/4 and L5/S1 among anemic patients (p < 0.05). In addition, we noticed that the incidence of multilevel LDD happened much more frequently in patients with anemia (p < 0.05). The Hb value showed a borderline negative correlation with the total score of DD (p = 0.056).

Conclusion

The results suggested that patients with anemia, and those without are radiologically different with varying patterns of DD. Patients with back pain and anemia were more likely to have extensive and severe DD. Although relevant mechanisms are not yet well understood, this study improved our understandings of the pathophysiology for LDD.

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Data availability

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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Author notes

  1. Hengrui Chang and Jiaxin Xu have contributed equally to this work.

Authors and Affiliations

  1. Department of Spinal Surgery, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People’s Republic of China

    Hengrui Chang, Jiaxin Xu & Wenyuan Ding

  2. Hebei Medical University, Shijiazhuang, 050051, Hebei, People’s Republic of China

    Hengrui Chang, Xiangyu Li & Ruoyu Zhao

  3. Department of Imaging, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People’s Republic of China

    Ming Wang

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  1. Hengrui Chang
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Contributions

WYD designed the study; HRC and JXX searched relevant studies; HRC, JXX and DLY 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., Xu, J., Li, X. et al. Association between anemia and lumbar disc degeneration in patients with low back pain: an observational retrospective study. Eur Spine J 32, 2059–2068 (2023). https://doi.org/10.1007/s00586-023-07652-1

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