Abstract/References

Relationship between lumbar disc degeneration on MRI and low back pain: A cross-sectional community study

Takehiro Watanabe, Koji Otani, Miho Sekiguchi, Shin-ichi Konno

Abstract

Purpose:Although an association has been suggested between disc degeneration (DD) and low back pain (LBP), some DD is thought to be an age-related change unrelated to symptoms. Age-inappropriate DD, however, may be associated with LBP. The purpose of this study was to investigate whether there is a difference in LBP and LBP-related quality of life between age-appropriate and age-inappropriate DD, as assessed by magnetic resonance imaging (MRI).

Participants and methods:In this cross-sectional study, degenerative change in the lumbar intervertebral discs of 382 subjects (age range, 27-82 years) was evaluated by MRI. Degenerative Disc Disease (DDD) scores were assigned using the Schneiderman classification, as the sum of grades for all intervertebral levels (0-15). We classified subjects into three groups according to age and DDD score: Low DD (mild DD relative to age), Appropriate (age-appropriate DD), and High DD (severe DD relative to age). We compared the three groups in terms of LBP prevalence, LBP intensity, LBP-specific quality of life (QOL) according to the Roland-Morris Disability Questionnaire (RDQ), and the Short Form-36 Item Health Survey (SF-36).

Results:Of 382 subjects, there were 35% in the Low DD group, 54% in the Appropriate group, and 11% in the High DD group. There were no significant differences among the groups in terms of prevalence of LBP, LBP intensity, RDQ score, or SF-36 score.

Conclusion:No association was found between age-inappropriate DD (Low or High DD group) and age-appropriate DD (Appropriate group) in terms of prevalence of LBP, LBP intensity, RDQ, or SF-36.

The content of research paper

References

1. Jervik JG, Deyo RA. Diagnostic evaluation of low back pain with emphasis on imaging. Ann Intern Med, 137(7):586-597, 2002.
2. Deyo RA, Cherkin D, Conrad D, Volinn Ee. Cost, controversy, crisis:low back pain and health of the public. Annu Rev Public Health, 12:141-156, 1991.
3. Atkinson HJ, Slater MA, Patterson TL, Grant I, Garfin SR. Prevalence, onset, and risk of psychiatric disorders in men with chronic low back pain:a controlled study. Pain, 45(2):111-121, 1991.
4. Yu SW, Sether LA, Ho PS, Wagner M, Haughton VM. Tears of the anulus fibrosus:correlation between MR and pathologic findings in cadavers. AJNR Am J Neuroradiol, 9(2):367-370, 1988.
5. Kjaer P, Leboeuf-Yde C, Sorensen JS, Bendix T. An Epidemiologic Study of MRI and Low Back Pain in 13-Year-Old Children. Spine (Phila Pa 1976), 30(7):798-806, 2005.
6. DeCandido P, Reinig JW, Dwyer AJ, Thompson KJ, Ducker TB. Magnetic Resonance Assessment of the Distribution of Lumbar Spine Disc Degenerative Changes. J Spinal Disord, 1(1):9-15, 1988.
7. Huang YC, Urban JP, Luk KD. Intervertebral disc regeneration:do nutrients lead the way ? Nat Rev Rheumatol, 10(9):561-566, 2014.
8. Risbud MV, Shapiro IM. Role of Cytokines in Intervertebral Disc Degeneration:Pain and Disc content. Nat Rev Rheumatol, 10(1):44-56, 2014.
9. Tertti MO, Salminen JJ, Paajanen HE, Terho PH, Kormano MJ. Low-back pain and disk dgeneration in children:a case-control MR imaging study. Radiology, 180(2):503-507, 1991.
10. Erkintalo MO, Salminen JJ, Alanen AM, Paajanen HE, Kormano MJ. Development of degenerative changes in the lumbar intervertebral disk:results of a prospective MR imaging study in adolescents with and without low-back pain. Radiology., 196(2):529-533, 1995.
11. Paajanen H, Erikintalo M, Kuusela T, Dahlstrom S, Kormano M. Magnetic resonance study of disc degeneration in young low-back pain patients. Spine (Phila Pa 1976), 14(9):982-985, 1989.
12. Luoma K, Riihimäki H, Luukkonen R, Raininko R, Viikari-Juntura E, Lamminen A. Low back pain in relation to lumbar disc degeneration. Spine (Phila Pa 1976), 25(4):487-492, 2000.
13. Samartzis D, Karppinen J, Mok F, Fong DY, Luk KD, Cheung KM. A population-based study of juvenile disc degeneration and its association with overweight and obesity, low back pain, and diminished functional status. J Bone Joint Surg Am, 93(7):662-670, 2011.
14. Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW. Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am, 72(3):403-408, 1990.
15. Boos N, Semmer N, Elfering A, et al. Natural history of individuals with asymptomatic disc abnormalities in magnetic resonance imaging:predictors of low back pain-related medical consultation and work incapacity. Spine (Phila Pa 1976), 25(12):1484-1492, 2000.
16. Savage RA, Whitehouse GH, Roberts N. The relationship between the magnetic resonance imaging appearance of the lumbar spine and low back pain , age and occupation in males. Eur Spine J, 6(2):106-114, 1997.
17. Powell MC, Wilson M, Szypryt P, Symonds EM, Worthington BS. Prevalence of lumbar disc degeneration observed by magnetic resonance in symptomless women. Lancet, 2(8520):1366-1367, 1986.
18. Boos N, Weissbach S, Rohrbach H, Weiler C, Spratt KF, Nerlich AG. Classification of age-related changes in lumbar intervertebral discs:2002 Volvo Award in basic science. Spine (Phila Pa 1976), 27(23):2631-2644, 2002.
19. Cheung KM, Karppinen J, Chan D, et al. Prevalence and pattern of lumbar magnetic resonance imaging changes in a population study of one thousand forty-three individuals. Spine (Phila Pa 1976), 34(9):934-940, 2009.
20. Teraguchi M, Yoshimura N, Hashizume H, et al. Prevalence and distribution of intervertebral disc degeneration over the entire spine in a population-based cohort:the Wakayama Spine Study. Osteoarthritis Cartilage, 22(1):104-110, 2014.
21. Lee S, Lee JW, Yeom JS, Kim HJ, Chung SK, Kang HS. A practical MRI grading system for lumbar foraminal stenosis. AJR Am J Roentgenol, 194(4):1095-1098, 2010.
22. Battié MC, Videman T, Parent E. Lumbar disc degeneration:epidemiology and genetic influences. Spine (Phila Pa 1976), 29(13):2679-2690. 23, 2004.
23. Kjaer P, Leboeuf-yde C, Korsholm L, et al. Magnetic Resonance Imaging and Low Back Pain in Adults:A Diagnostic Imaging Study of 40-Year-Old Men and Women. Spine (Phila Pa 1976), 30:1173-1180, 2005.
24. Al-saeed O, Al-jarallah K, Raeess M, Sheikh M, Ismail M, Athyal R. Magnetic resonance imaging of the lumbar spine in young arabs with low back pain. Asian Spine J, 6(4):249-256, 2012.
25. Kikuchi S. New concept for backache:biopsy­chosocial pain syndrome. Eur Spine J, 17(Suppl 4):421-427, 2008.
26. Otani K, Kikuchi S, Nikaido T, Konno SI. Magnitude of dural tube compression does not show a predictive value for symptomatic lumbar spinal stenosis for 1-year follow-up:a prospective cohort study in the community. Clin Interv Aging, 13:1739-1746, 2018.
27. BRINKMAN GL, COATES EO jr. The effect of bronchitis, smoking,and occupation on ventilation. Am Rev Respir Dis, 87:684-693, 1963.
28. Konno S, Suzukamo Y, Fukuhara S. Cross-cultural adaptation of the Japanese version of the Roland-Morris Disabitity Questionnaire. Seikei Geka, 54:958-693, 2003.
29. Suzukamo Y, Fukuhara S, Kikuchi S, et al. Vadlidation of the Japanese Version of the Roland-Morris Disability Questionnaire. J orthop Sci, 8:543-548, 2003.
30. Fukuhara S, Ware JE Jr, Kosinski M, Wada S, Gandek B. Psychometric and clinical tests of validity of the Japanese SF-36 Health Survey. J Clin Epidemiol, 51(11):1045-1053, 1998.
31. Fukuhara S, Bito S, Green J, Hsiao A, Kurokawa K. Translation, adaptation, and validation of the SF-36 Health Survey for use in Japan. J Clin Epidemiol, 51(11):1037-1044, 1998.
32. Fukuhara S, Suzukamo Y. Manual of the SF-36v2 Japanese Version. Kyoto, Japan:Institute for Health Outcomes and ProcessEvaluation Research. Health (Irvine Calif), 10.
33. Schneiderman G, Flannigan B, Kingston S, Thomas J, Dillin WH, Watkins RG. Magnetic resonance imaging in the diagnosis of disc degeneration:correlation with discography. Spine (Phila Pa 1976), 12(3):276-281, 1987.
34. Kawaguchi Y, Kanamori M, Ishihara H, Ohmori K, Matsui H, Kimura T. The association of lumbar disc disease with vitamin-D receptor gene polymorphism. J Bone Joint Surg Am, 84(11):2022-2028, 2002.
35. Serlin RC, Mendoza TR, Nakamura Y, Edwards KR, Cleeland CS. When is cancer pain mild, moderate or severe ? Grading pain severity by its interference with function. Pain, 61(2):277-284, 1995.
36. Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med, 331(2):69-73, 1994.
37. Takahashi N, Kikuchi S, Konno S, Morita S, Suzuamo Y, Green J, Fukuhara S. Discrepancy between disability and the severity of low back pain:demographic, psychologic , and employment-related factors. Spine (Phila Pa 1976), 31(8):931-939, 2006.
38. Landis JR, Koch GG. The measurement of observer agreement for categorial data. Biometrics, 33(1):159-174, 1977.
39. Papageorgiou AC, Croft PR, Thomas E, Ferry S, Jayson MI, Silman AJ. Influence of previous pain experience on the episode incidence of low back pain: results from the South Manchester Back Pain Study. Pain, 66(2-3):181-185, 1996.
40. Wang YXJ. Postmenopausal Chinese women show accelerated lumbar disc degeneration compared with Chinese men. J Orthop Translat., 3(4):205-211, 2015.
41. Hestbeak L, Leboeuf-Yde C, Kyvik KO. Are lifestyle-factors in adolescence predictors for adult low back pain ? A cross-sectional and prospective study of young twins. BMC Musculoskelet Disord., 15(7):27, 2006.
42. Videman T, Gibbons LE, Kaprio J, Battié MC. Challenging the cumulative injury model:positive effects of greater body mass on disc degeneration. Spine J., 10(1):26-31, 2010.
43. Williams FM, Popham M, Sambrook PN, Jones AF, Spector TD, MacGregor AJ. Progression of lumbar disc degeneration over decade:a heritability study. Ann Rheum Dis., 70(7):1203-1207, 2011.
44. Dario AB, Ferreira ML, Refshauge KM, Lima TS, Ordoñana JR, Ferreira PH. The relationship between obesity, low back pain and lumbar disc degeneration when genetics and the environment are considered:a systematic review of twin studies. Spine J 15(5):1106-1117, 2015.
45. Battié MC, Videman T, Gill K, Moneta GB, Nyman R, Kaprio J, Koskenvuo M. 1991 Volvo Award in clinical sciences. Smoking and lumbar intervertebral disc degeneration:an MRI study of identical twins. Spine (Phila Pa 1976), 16(9):1015-1021, 1991.
46. Holm S, Nachemson A. Nutrition of the intervertebral disc:acute fffects of cigarette smoking. An experimental animal study. Ups J Med Sci., 93(1):9-9, 1988.
47. Iwahashi M, Matsuzaki H, Tokuhashi Y, Wakabayashi K, Uematsu Y. Mechanism of intervertebral disc degeneration caused by nicotine in rabbits to explicate intervertebral disc disorders caused by smoking. Spine (Phila Pa 1976), 27(13):1396-1401, 2002.
48. Corniola MV, Stienen MN, Joswig H, Smoll NR, Schaller K, Hildebrandt G, Gautschi OP. Correlation of pain, functional impairment, and health-related quality of life with radiological grading scales of lumbar degenerative disc disease. Acta Neurochir (Wien)., 158(3):499-505, 2016.
49. Jarvik JG, Hollingworth W, Heagerty PJ, Haynor DR, Boyko EJ, Deyo RA. Three-year incidence of low back pain in an initially asymptomatic cohort clinical and imaging risk factors. Spine (Phila Pa 1976)., 30(13):1541-1548, 2005.
50. Shambrook J, McNee P, Harris CE, Kim M, Sampson M, Palmer KT, Coggon D. Clinical presentation of low back pain and ssociation with risk factors according to findings on magnetic resonance imaging. Pain, 152(7):1659-1665, 2011.

Figures (8)