Association of lumbar disc degeneration with low back pain in middle age in the Northern Finland Birth Cohort 1966

Abstract

Background Although it has been suggested that lumbar disc degeneration (LDD) is a significant risk factor for low back pain (LBP), its role remains uncertain. Our objective was to clarify the association between LDD and LBP and whether mental distress modifies the association. Methods Participants of a birth cohort underwent 1.5-T lumbar magnetic resonance imaging at the age of 47. The association between the sum score of LDD (Pfirrmann classification, range 0–15) and LBP (categorized into “no pain”, “mild-to-moderate pain”, “bothersome-and-frequent pain”) was assessed using logistic regression analysis, with sex, smoking, body mass index, physical activity, occupational exposure, education, and presence of Modic changes and disc herniations as confounders. The modifying role of mental distress (according to the Hopkins Symptom Check List-25 [HSCL-25], the Beck Depression Inventory and the Generalized Anxiety Disorder Scale) in the association was analyzed using linear regression. Results Of the study population (n = 1505), 15.2% had bothersome and frequent LBP, and 29.0% had no LBP. A higher LDD sum score increased the odds of belonging to the “mild-to-moderate pain” category (adjusted OR corresponding to an increase of one point in the LDD sum score 1.11, 95% CI 1.04–1.18, P = 0.003) and the “bothersome-and-frequent pain” category (adjusted OR 1.20, 95% CI 1.10–1.31, P < 0.001), relative to the “no pain” category. Mental distress significantly modified the association between LDD and LBP, as a linear positive association was consistently observed among individuals without mental distress according to HSCL-25 (adjusted B 0.16, 95% CI 0.07–0.26, P < 0.001), but not among individuals with higher mental distress. Conclusions LDD was significantly associated with both mild-to-moderate and bothersome-and-frequent LBP. However, the co-occurrence of mental distress diminished the association between LDD and LBP bothersomeness. Our results strongly suggest that mental symptoms affect the pain experience.

Early disc degeneration in radiotherapy-treated childhood brain tumor survivors

“…Survivors had an increased prevalence of lumbar disc herniations, but further studies are required to better understand the long-term consequences of IVD in this population. Lumbar IVD degeneration is associated with low back pain [16,17]. A previous publication of the same BT survivor population showed a trend toward reporting increased pain compared to healthy controls, but this association did not reach signi cance [27].…”

“…Previous studies have shown that IVD degeneration can be identi ed in childhood; however, the prevalence increases with age [15]. Soon after the phase of rapid physical growth, individuals with lumbar IVD have an increased risk of recurrent lower back pain; in adulthood, individuals are predisposed to long-term risk of recurrent pain [14][15][16][17][18]. Early disc degeneration, if detected, may result in long-term recurrent pain in the survivors and further decrease their health-related quality of life.…”

External Validation of SpineNet, an Open-Source Deep Learning Model for Grading Lumbar Disk Degeneration MRI Features, Using the Northern Finland Birth Cohort 1966

“…A fourth expert rater determined the consensus Pfirrmann grade. 15 For historical reasons, Pfirrmann grades 1 and 2 were considered as grade 2. MC were evaluated by two blinded raters with specific experience in MC evaluation, with an interrater reliability of κ = 0.82.…”

ISSLS PRIZE in Clinical Science 2023: comparison of degenerative MRI features of the intervertebral disc between those with and without chronic low back pain. An exploratory study of two large female populations using automated annotation

“…However, should the possible clinical relevance of MRI findings of disc degeneration be discounted? Studies, including a systematic review, have found that overall prevalence of disc degeneration and of degenerative features, such as Modic changes [4], were significantly greater in those with LBP, than in asymptomatics [5][6][7]. But others find no such relationship [8,9].…”