Abstract
Introduction
The objective of this study was to assess the association between severe disc degeneration (DD) and low back pain (LBP).
Methods
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.
Results
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).
Conclusions
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.
Similar content being viewed by others
Abbreviations
- BMI:
-
Body mass index
- DD:
-
Disc degeneration
- LBP:
-
Low back pain
- P25:
-
25th percentile
- P75:
-
75th percentile
- RMQ:
-
Roland–Morris Questionnaire
- VAS:
-
Visual analog scale
References
Walker BF (2000) The prevalence of low back pain: a systematic review of the literature from 1966 to 1998. J Spinal Disord 13:205–217
Vos T, Flaxman AD, Naghavi M et al (2012) Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380:2163–2196
Modic MT, Ross JS (2007) Lumbar degenerative disk disease. Radiology 1:43–61
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 59–111
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
Brayda-Bruno M, Tibiletti M, Ito K et al (2013) Advances in the diagnosis of degenerated lumbar discs and their possible clinical application. Eur Spine J. doi:10.1007/s00586-013-2960-9
Chou D, Samartzis D, Bellabarba C et al (2011) Degenerative magnetic resonance imaging changes in patients with chronic low back pain: a systematic review. Spine 36(21 Suppl):S43–S53
Chou R, Qaseem A, Snow V et al (2007) Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med 147:478–491
Kjaer P, Leboeuf-Yde C, Korsholm L et al (2005) Magnetic resonance imaging and low back pain in adults: a diagnostic imaging study of 40-year-old men and women. Spine 30:1173–1180
Takatalo J, Karppinen J, Niinimäki J et al (2011) Does lumbar disc degeneration on magnetic resonance imaging associate with low back symptom severity in young Finnish adults? Spine 36:2180–2189
Carragee EJ, Alamin TF, Miller JL et al (2005) Discographic, MRI and psychosocial determinants of low back pain disability and remission: a prospective study in subjects with benign persistent back pain. Spine J 5:24–35
Carragee E, Alamin T, Cheng I et al (2006) Are first-time episodes of serious LBP associated with new MRI findings? Spine J 6:624–635
Merskey HB, Bogduk N (1994) Detailed descriptions of pain syndromes. In: Merskey HB, Bogduk N (eds) Classification of chronic pain. IASP, Seattle, pp 39–58
Arana E, Kovacs FM, Royuela A et al (2011) Modic changes and associated features in Southern European chronic low back pain patients. Spine J 11:402–411
Cheung KM, Karppinen J, Chan D et al (2009) Prevalence and pattern of lumbar magnetic resonance imaging changes in a population study of one thousand forty-three individuals. Spine 34:934–940
Kuorinka I, Jonsson B, Kilbom A et al (1987) Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon 18:233–237
Huskisson EC (1974) Measurement of pain. Lancet 2:1127–1131
Kovacs FM, Llobera J, Gil Del Real MT et al (2002) Validation of the Spanish version of the Roland-Morris questionnaire. Spine 27:538–542
Arana E, Royuela A, Kovacs FM et al (2010) Agreement in the interpretation of 1.5 T magnetic resonance images of the lumbar spine using the Nordic Modic Consensus Group Classification form. Radiology 254:809–817
Pfirrmann CW, Metzdorf A, Zanetti M et al (2001) Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine 26:1873–1878
Jensen TS, Sorensen JS, Kjaer P (2007) Intra- and interobserver reproducibility of vertebral endplate signal (Modic) changes in the lumbar spine: the Nordic Modic Consensus Group classification. Acta Radiol 48:748–754
Arana E, Kovacs FM, Royuela A et al (2011) The influence of nomenclature in the interpretation of lumbar disk contour on MRI: a comparison of the agreement using the Combined Task Force and the Nordic nomenclatures. AJNR Am J Neuroradiol 32:1143–1148
Carrino JA, Lurie JD, Tosteson ANA et al (2009) Lumbar spine: reliability of MR imaging findings. Radiology 250(1):161–170
Jensen TS, Kjaer P, Korsholm L et al (2010) Predictors of new vertebral endplate signal (Modic) changes in the general population. Eur Spine J 19:129–135
Videman T, Battie MC, Parent E et al (2008) Progression and determinants of quantitative magnetic resonance imaging measures of lumbar disc degeneration: a five-year follow-up of adult male monozygotic twins. Spine 33:1484–1490
Belsley DA (1991) Conditioning diagnostics: collinearity and weak data in regression. Wiley, New York
Vandenbroucke JP, von Elm E, Altman DG et al (2007) Strengthening the reporting of observational studies in epidemiology: explanation and elaboration. Epidemiology 18:805–835
Shambrook J, McNee P, Harris EC et al (2011) Clinical presentation of low back pain and association with risk factors according to findings on magnetic resonance imaging. Pain 152:1659–1665
Kovacs FM, Arana E, Royuela A et al (2012) Vertebral endplate changes are not associated with chronic low back pain among Southern European subjects. A case control study. AJNR Am J Neuroradiol 33:1519–1524
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:1306–1311
Gallucci M, Anselmi M, Di Sibio A, Gregori LM (2011) Annular tears, fissures or HIZ? Neuroradiology 53(Suppl 1):S161–S165
Jensen MC, Brant-Zawadzki MN, Obuchowski N et al (1994) Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med 331:69–73
Peters ML, Vlaeyen JW, Weber WE (2005) The joint contribution of physical pathology, pain-related fear and catastrophizing to chronic back pain disability. Pain 113:40–45
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 12:1008–1017
Kovacs FM, Seco J, Royuela A et al (2012) The prognostic value of catastrophizing for predicting the clinical evolution of low back pain patients. A study in routine clinical practice within the Spanish National Health Service [NCT00502333]. Spine J 12:545–555
Acknowledgments
This study was funded by The Kovacs Foundation, a not-for-profit institution specializing in back pain research, with no links to the health industry. The Kovacs Foundation was not involved in the design and conduction of the study, data collection, management, analysis and interpretation of the data, preparation, review and approval of the manuscript, or in the decision to submit the article for publication.
Conflict of interest
We declare that we have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Supplementary Table
(DOCX 13 kb)
Rights and permissions
About this article
Cite this article
Kovacs, F.M., Arana, E., Royuela, A. et al. Disc degeneration and chronic low back pain: an association which becomes nonsignificant when endplate changes and disc contour are taken into account. Neuroradiology 56, 25–33 (2014). https://doi.org/10.1007/s00234-013-1294-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00234-013-1294-y