Associations between disc space narrowing, anterior osteophytes and disability in chronic mechanical low back pain: a cross sectional study

Abstract

BackgroundRadiographic features of lumbar disc degeneration (LDD) are common findings in patients with chronic mechanical low back pain; however, its role in disability and intensity of pain is debatable. This study aims to investigate the associations of the x-ray features of LDD and lumbar spondylolisthesis with severity of disability and intensity of pain.MethodsA cross-sectional study was conducted on 439 patients with chronic mechanical low back pain who attended the rheumatology clinic, National Hospital of Sri Lanka, Colombo, from May 2012 to May 2014. Severity of disability was measured using Modified Oswestry Disability Index and intensity of pain was assessed using numeric rating scale (0–100). X-ray features of LDD (disc space narrowing, anterior osteophytes and overall LDD) and spondylolisthesis were assessed in lateral recumbent lumbar x-rays (L1/L2 to L5/S1) and graded by a consultant radiologist blinded to clinical data. Generalised linear model with linear response was used to assess the associations of x-ray features of LDD with severity of disability and intensity of pain adjusting for age, gender, body mass index and pain radiating into legs.ResultsMean age was 48.99 ± 11.21 and 323 (73.58%) were females. 87 (19.82%) were obese. Mean severity of disability was 30.95 ± 13.67 and mean intensity of pain was 45.50 ± 20.37. 69 (15.72%), 26 (5.92%) and 85 (19.36%) patients had grade 2 disc space narrowing, anterior osteophytes and overall LDD, respectively. 51 (11.62%) patients had lumbar spondylolisthesis. Grade of disc space narrowing and overall LDD were not associated with severity of disability or intensity of pain. The presence of lumbar spondylolisthesis was associated with severity of disability. Female gender and pain radiating into legs were associated with severity of disability and intensity of pain. Advancing age was associated with x-ray features of LDD and lumbar spondylolisthesis.ConclusionsLumbar spondylolisthesis is associated with severity of disability in patients with chronic mechanical low back pain. Associations of x-ray features of LDD with severity of disability and intensity of pain are inconclusive. Female gender and pain radiating into legs are significant confounders.

Role of lumbar disc degeneration and genetic variation in chronic low back pain

“…Most of these studies are done as population based studies and restricted to middle aged/elderly individuals or one gender. In contrast, clinic based studies have failed to identify a significant association between the x-ray features of LDD and intensity of LBP or disability [29,41,42].…”

“…The imbalance between the degradation and inhibitory pathways is also increased with disc degeneration [27,28]. Our recent cross sectional study done in Sri Lanka reported that advanced degenerative features of the spine were present in younger patients (20-29 years) with chronic LBP raising the question that LDD may not be entirely age related [29].…”

“…Our recent cross sectional study in patients with chronic mechanical LBP, revealed that x-ray features, specially disc space narrowing and anterior osteophytes were not associated with intensity of pain or severity of disability. Lumbar spondylolisthesis was the only x-ray feature which predicted increased severity of disability [29]. Lumbar spondylolisthesis is an advanced degenerative feature and it leads to alignment instability in the spine [13].…”

A Momentary Impact Injury of Vertebral Endplates, even without Structural Disruption, Initiates Disc Degeneration In Vitro.

“…Authors' information (optional) 1 Department of Spine Surgery, Qingdao west coast new area central hospital of Binzhou medical college, Qingdao, China…”

“…Intervertebral disc degeneration (IDD) is strongly associated with low back pain (LBP) [1,2], which accounts for about $100 billion in annual medical expenditure lost wages, and decreased productivity in the of the United States [3]. Degeneration of the disc is usually attributed to aging ageing, genetic, mechanical, and nutritional factors, the environment and individual which is characterized by a decrease in proteoglycans, cell population, water content, and loss of disc height [4].…”