Advertisement

Journal of Zhejiang University-SCIENCE B

, Volume 19, Issue 7, pp 547–558 | Cite as

Methodology and cohort profile for the Hangzhou Lumbar Spine Study: a study focusing on back health in a Chinese population

  • Xiao-jian Hu
  • Lun-hao Chen
  • Michele C. Battié
  • Yue Wang
Article
  • 2 Downloads

Abstract

Back pain is a worldwide health problem, adding a tremendous burden to modern societies. However, little information on back health is available in China, even though a quarter of the world’s population is Chinese. To enhance knowledge in this area, we designed and initiated the Hangzhou Lumbar Spine Study, which is a cross-sectional study of a general sample of mainland Chinese with focusing on disc degeneration, Modic changes, endplate lesions, and back pain. The study consists of a structured questionnaire to measure back pain history and lifetime exposure to suspected risk factors, magnetic resonance imaging of the lumbar spine, bone mineral density study of the spine and hip, and DNA sample analysis. Here we briefly introduce the study methodology, report the test-retest reliability of the questionnaire, and describe the cohort profile to date. Since May 2014, 301 randomly selected subjects (male/female, 122/179; mean age, 51.0 years; range, 20–87 years) have been recruited. Tests-retests of the questionnaire, completed by 40 participants, revealed good reliability. To our knowledge, the Hangzhou Lumbar Spine Study is the first population-based epidemiological study conducted to characterize lumbar spinal phenotypes and back pain, their interaction, and their associations with lifetime environmental exposure, in mainland Chinese. Epidemiological information obtained from a reliable questionnaire, magnetic resonance (MR) imaging data, dual energy X-ray absorptiometry (DXA) measurements, and DNA analysis may serve as a valuable reference for future studies on back health, particularly for mainland Chinese.

Key words

Back pain Population-based study Disc degeneration Modic change Endplate lesion Methodology 

基于中国一般人群腰痛的杭州腰椎研究的方法学及进展介绍

中文概要

目的

开展基于大样本人群的杭州腰椎疾患研究,研究 国人一般人群腰痛、腰椎间盘退变、终板病损、 Modic 改变的流行病学特征以及病理机制。

创新点

开展了中国大陆第一个基于大样本的有关腰痛、 腰椎间盘退变、终板病损、Modic 改变的流行病 学研究;开发了一份可信度高的包含腰痛病史以 及相关风险因素的调查问卷;采用高分辨率3.0 T 核磁共振来分辨腰椎病变特征。

方法

从杭州采荷社区中随机抽取人群,完成调查问卷 腰痛相关信息记录、腰椎核磁共振扫描、腰椎及 股骨颈骨密度测量以及血液样本抽取。从参与人 群重复抽取40 人进行问卷可信度测量。调查问 卷包含的信息包括,人群一般资料、吸烟史、腰 痛史、职业史以及运动史,用来记录腰痛发生情 况以及相关风险因素。腰椎核磁共振扫描用于观 察椎间盘退变、Modic 改变以及终板病损等腰椎 特征性病变。骨密度测量用来研究与腰椎特征性 病变的联系。血液样本用于后续遗传因素的分 析。

结论

目前已完成301 名社区人员调查问卷腰痛相关信 息记录、腰椎核磁共振扫描、腰椎及股骨颈骨密 度测量以及血液样本抽取;有关腰痛以及相关风 险因素的调查问卷可信度高;杭州腰椎疾患研究 可对国人腰痛、腰椎间盘退变、终板病损、Modic 改变的流行病学特征以及进一步的病理机制研 究提供有价值的信息。

关键词

腰痛 大样本研究 椎间盘退变 Modic改变 终板缺损 方法学 

CLC number

R681.5 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Abraham I, Killackey-Jones B, 2002. Lack of evidence-based research for idiopathic low back pain: the importance of a specific diagnosis. Arch Intern Med, 162 (13):1442–1444. https://doi.org/10.1001/archinte.162.13.1442CrossRefPubMedGoogle Scholar
  2. Albert HB, Manniche C, 2007. Modic changes following lumbar disc herniation. Eur Spine J, 16(7):977–982. https://doi.org/10.1007/s00586-007-0336-8CrossRefPubMedPubMedCentralGoogle Scholar
  3. Andersson GBJ, 1999. Epidemiological features of chronic low-back pain. Lancet, 354(9178):581–585.CrossRefPubMedGoogle Scholar
  4. Balagué F, Mannion AF, Pellise F, et al., 2012. Non-specific low back pain. Lancet, 379(9814):482–491. https://doi.org/10.1016/S0140-6736(11)60610-7CrossRefPubMedGoogle Scholar
  5. Battié MC, Videman T, 2006. Lumbar disc degeneration: epidemiology and genetics. J Bone Joint Surg Am, 88(Suppl 2):3–9.PubMedGoogle Scholar
  6. Battié MC, Videman T, Gibbons LE, et al., 1995. Determinants of lumbar disc degeneration: a study relating lifetime exposures and magnetic resonance imaging findings in identical twins. Spine, 20(24):2601–2612. https://doi.org/10.1097/00007632-199512150-00001CrossRefPubMedGoogle Scholar
  7. Battié MC, Videman T, Levalahti E, et al., 2007. Heritability of low back pain and the role of disc degeneration. Pain, 131(3):272–280. https://doi.org/10.1016/j.pain.2007.01.010CrossRefPubMedGoogle Scholar
  8. Bush K, 1998. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Arch Intern Med, 158(16):1789–1795. https://doi.org/10.1001/archinte.158.16.1789CrossRefPubMedGoogle Scholar
  9. Deyo RA, Weinstein JN, 2001. Low back pain. New Engl J Med, 344(5):363–370.CrossRefPubMedGoogle Scholar
  10. Dionne CE, Dunn KM, Croft PR, et al., 2008. A consensus approach toward the standardization of back pain definitions for use in prevalence studies. Spine, 33(1):95–103. https://doi.org/10.1097/BRS.0b013e31815e7f94CrossRefPubMedGoogle Scholar
  11. Halpern M, Hiebert R, Nordin M, et al., 2001. The test-retest reliability of a new occupational risk factor questionnaire for outcome studies of low back pain. Appl Ergon, 32(1): 39–46. https://doi.org/10.1016/S0003-6870(00)00045-4CrossRefPubMedGoogle Scholar
  12. Jarvik JG, Hollingworth W, Heagerty PJ, et al., 2005. Three-year incidence of low back pain in an initially asymptomatic cohort: clinical and imaging risk factors. Spine, 30(13):1541–1548. https://doi.org/10.1097/01.brs.0000167536.60002.87CrossRefPubMedGoogle Scholar
  13. Jarvinen J, Karppinen J, Niinimaki J, et al., 2015. Association between changes in lumbar Modic changes and low back symptoms over a two-year period. BMC Musculoskelet Disord, 16:98. https://doi.org/10.1186/s12891-015-0540-3CrossRefPubMedPubMedCentralGoogle Scholar
  14. Jensen MC, Brant-Zawadzki MN, Obuchowski N, et al., 1994. Magnetic resonance imaging of the lumbar spine in people without back pain. New Engl J Med, 331(2):69–73. https://doi.org/10.1056/NEJM199407143310201CrossRefPubMedGoogle Scholar
  15. Kaapa E, Luoma K, Pitkaniemi J, et al., 2012. Correlation of size and type of Modic types 1 and 2 lesions with clinical symptoms: a descriptive study in a subgroup of patients with chronic low back pain on the basis of a university hospital patient sample. Spine, 37(2):134–139. https://doi.org/10.1097/BRS.0b013e3182188a90CrossRefPubMedGoogle Scholar
  16. Kjaer P, Leboeuf-Yde C, Sorensen JS, et al., 2005a. An epidemiologic study of MRI and low back pain in 13-yearold children. Spine, 30(7):798–806. https://doi.org/10.1097/01.brs.0000157424.72598.ecCrossRefPubMedGoogle Scholar
  17. Kjaer P, Leboeuf-Yde C, Korsholm L, et al., 2005b. Magnetic resonance imaging and low back pain in adults: a diagnostic imaging study of 40-year-old men and women. Spine, 30(10):1173–1180. https://doi.org/10.1097/01.brs.0000162396.97739.76CrossRefPubMedGoogle Scholar
  18. Kuisma M, Karppinen J, Niinimaki J, et al., 2007. Modic changes in endplates of lumbar vertebral bodies prevalence and association with low back and sciatic pain among middle-aged male workers. Spine, 32(10):1116–1122. https://doi.org/10.1097/01.brs.0000261561.12944.ffCrossRefPubMedGoogle Scholar
  19. Kuisma M, Karppinen J, Haapea M, et al., 2009. Modic changes in vertebral endplates: a comparison of MR imaging and multislice CT. Skeletal Radiol, 38(2):141–147. https://doi.org/10.1007/s00256-008-0590-9CrossRefPubMedGoogle Scholar
  20. Landis JR, Koch GG, 1977. The measurement of observer agreement for categorical data. Biometrics, 33(1):159–174. https://doi.org/10.2307/2529310CrossRefPubMedGoogle Scholar
  21. Maatta JH, Wadge S, MacGregor A, et al., 2015. ISSLS prize winner: vertebral endplate (Modic) change is an independent risk factor for episodes of severe and disabling low back pain. Spine, 40(15):1187–1193. https://doi.org/10.1097/BRS.0000000000000937CrossRefPubMedGoogle Scholar
  22. MacGregor AJ, Andrew T, Sambrook PN, et al., 2004. Structural, psychological, and genetic influences on low back and neck pain: a study of adult female twins. Arthritis Care Res, 51(2):160–167. https://doi.org/10.1002/art.20236CrossRefGoogle Scholar
  23. Mok FP, Samartzis D, Karppinen J, et al., 2010. ISSLS prize winner: prevalence, determinants, and association of Schmorl nodes of the lumbar spine with disc degeneration: a population-based study of 2449 individuals. Spine, 35(21):1944–1952. https://doi.org/10.1097/BRS.0b013e3181d534f3CrossRefPubMedGoogle Scholar
  24. Mok FP, Samartzis D, Karppinen J, et al., 2016. Modic changes of the lumbar spine: prevalence, risk factors, and association with disc degeneration and low back pain in a large-scale population-based cohort. Spine J, 16(1):32–41. https://doi.org/10.1016/j.spinee.2015.09.060CrossRefPubMedGoogle Scholar
  25. Moore C, Bolton T, Walker M, et al., 2016. Recruitment and representativeness of blood donors in the INTERVAL randomised trial assessing varying inter-donation intervals. Trials, 17(1):458. https://doi.org/10.1186/s13063-016-1579-7CrossRefPubMedPubMedCentralGoogle Scholar
  26. Pincus T, Santos R, Breen A, et al., 2008. A review and proposal for a core set of factors for prospective cohorts in low back pain: a consensus statement. Arthritis Rheum, 59(1):14–24. https://doi.org/10.1002/art.23251CrossRefPubMedGoogle Scholar
  27. Rahme R, Moussa R, 2008. The Modic vertebral endplate and marrow changes: pathologic significance and relation to low back pain and segmental instability of the lumbar spine. Am J Neuroradiol, 29(5):838–842. https://doi.org/10.3174/ajnr.A0925CrossRefPubMedGoogle Scholar
  28. Salminen JJ, Erkintalo M, Laine M, et al., 1995. Low back pain in the young. A prospective three-year follow-up study of subjects with and without low back pain. Spine, 20(19): 2101–2108. https://doi.org/10.1097/00007632-199510000-00006PubMedGoogle Scholar
  29. Teraguchi M, Yoshimura N, Hashizume H, et al., 2015. The association of combination of disc degeneration, end plate signal change, and Schmorl node with low back pain in a large population study: the Wakayama Spine Study. Spine J, 15(4):622–628. https://doi.org/10.1016/j.spinee.2014.11.012CrossRefPubMedGoogle Scholar
  30. Todd M, Davis KE, Cafferty TP, 1983. Who volunteers for adult development research?: research findings and practical steps to reach low volunteering groups. Int J Aging Hum Dev, 18(3):177–184. https://doi.org/10.2190/AYK2-QRJ7-N8PU-M9B5CrossRefPubMedGoogle Scholar
  31. Wang Y, Videman T, Battié MC, 2012a. ISSLS prize winner: lumbar vertebral endplate lesions: associations with disc degeneration and back pain history. Spine, 37(17):1490–1496. https://doi.org/10.1097/BRS.0b013e3182608ac4CrossRefPubMedGoogle Scholar
  32. Wang Y, Videman T, Battié MC, 2012b. Modic changes: prevalence, distribution patterns, and association with age in white men. Spine J, 12(5):411–416. https://doi.org/10.1016/j.spinee.2012.03.026CrossRefPubMedPubMedCentralGoogle Scholar
  33. Wang Y, Battié MC, Videman T, 2012c. A morphological study of lumbar vertebral endplates: radiographic, visual and digital measurements. Eur Spine J, 21(11):2316–2323. https://doi.org/10.1007/s00586-012-2415-8CrossRefPubMedPubMedCentralGoogle Scholar
  34. Wang Y, Videman T, Battié MC, 2013. Morphometrics and lesions of vertebral end plates are associated with lumbar disc degeneration: evidence from cadaveric spines. J Bone Joint Surg Am, 95(5):e26. https://doi.org/10.2106/JBJS.L.00124CrossRefPubMedGoogle Scholar
  35. Weir JP, 2005. Quantifying test-retest reliability using the intraclass correlation coefficient and the SEM. J Strength Cond Res, 19(1):231–240. https://doi.org/10.1519/00124278-200502000-00038PubMedGoogle Scholar
  36. World Health Organization, 2002. Reducing Risks, Promoting Healthy Life: the World Health Report 2012. http://www. who.int/whr/2002/en [Accessed on Sept. 10, 2015].Google Scholar

Copyright information

© Zhejiang University and Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Spine Lab, Department of Orthopedic Surgery, the First Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouChina
  2. 2.Faculty of Rehabilitation MedicineUniversity of AlbertaEdmonton AB T6G 2G4Canada

Personalised recommendations