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Are serum thyroid hormone, parathormone, calcium, and vitamin D levels associated with lumbar spine degeneration? A cross-sectional observational clinical study

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Abstract

Purpose

Low back pain (LBP) impairs the quality of life and rises healthcare costs. The association of spine degeneration and LBP with metabolic disorders have been reported, previously. However, metabolic processes related with spine degeneration remained unclear. We aimed to analyze whether serum thyroid hormones, parathormone, calcium, and vitamin D levels were associated with lumbar intervertebral disc degeneration (IVDD), Modic changes, and fatty infiltration in the paraspinal muscles.

Methods

We cross-sectionally analyzed a retrospective database. Patients who visited internal medicine outpatient clinics with suspect of endocrine disorders and chronic LBP were searched. Patients with biochemistry results within 1 week before lumbar spine magnetic resonance imaging (MRI) were included. Age- and gender-matched cohorts were made-up and analyzed.

Results

Patients with higher serum free thyroxine levels were more likely to have severe IVDD. They were also more likely to have fattier multifidus and erector spinae at upper lumbar levels, less fatty psoas and less Modic changes at lower lumbar levels. Higher PTH levels were observed in patients with severe IVDD at L4-L5 level. Patients with lower serum vitamin D and calcium levels had more Modic changes and fattier paraspinal muscles at upper lumbar levels.

Conclusion

Serum hormone, vitamin D, and calcium levels were associated with not only IVDD and Modic changes but also with fatty infiltration in the paraspinal muscles, mainly at upper lumbar levels in patients with symptomatic backache presenting to a tertiary care center. Complex inflammatory, metabolic, and mechanical factors present in the backstage of spine degeneration.

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Acknowledgements

We dedicate this study to the ones who lost their lives or beloved ones in the great earthquake disaster in Turkey and Syria.

Author information

Authors and Affiliations

  1. Associate Professor of Neurosurgery, FSM Training and Research Hospital, Neurosurgery Clinic, Göztepe Mah. Mesire Sok. Tütüncü Mehmet Efendi Cad. No: 3/34 Kadıkoy, Istanbul, Turkey

    Murat Şakir Ekşi

  2. School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey

    Ömer Orhun & Yaren Nur Demir

  3. Endocrinology Unit, Department of Internal Medicine, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey

    Müjdat Kara

  4. Neurosurgery Clinic, Taksim Training and Research Hospital, Istanbul, Turkey

    Gürkan Berikol

  5. Department of Physical Medicine and Rehabilitation, School of Medicine, Bahçeşehir University, Istanbul, Turkey

    Emel Ece Özcan-Ekşi

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Correspondence to Murat Şakir Ekşi.

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Ekşi, M.Ş., Orhun, Ö., Demir, Y.N. et al. Are serum thyroid hormone, parathormone, calcium, and vitamin D levels associated with lumbar spine degeneration? A cross-sectional observational clinical study. Eur Spine J 32, 1561–1574 (2023). https://doi.org/10.1007/s00586-023-07673-w

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