Objective

Low back pain is a common public health problem associated with lumbar intervertebral disc degeneration. It is still unclear, whether intervertebral disc degeneration is an isolated process or accompanied by other degenerative events. We aimed to analyze whether disc degeneration was associated with vertebral end-plate changes and fatty infiltration in the paraspinal muscles. We also aimed to identify whether severity of disc degeneration influenced this association.

Patients and Methods

Intervertebral disc degeneration, vertebral end-plate changes, and fatty infiltration in the multifidus, erector spinae and psoas muscles at all lumbar intervertebral disc levels were evaluated on lumbar spine MRIs of 50 symptomatic females and age-matched 50 symptomatic males.

Results

Females had higher lumbar intervertebral disc degeneration scores at L4-5, L5-S1 levels and in total. Females had more fatty infiltration in the multifidus and erector spinae muscles at L4-5 and L5-S1 levels, while males had more fatty infiltration in the psoas muscle at L5-S1 level. Patients with severe intervertebral disc degeneration were more likely to have increased fatty infiltration in the multifidus and erector spinae muscles. The rate of having vertebral end-plate changes was also higher in patients with severe intervertebral disc degeneration.

Conclusions

Severe disc degeneration in the lumbar spine is closely associated with Modic changes, and fatty infiltration in the multifidus and erector spinae muscles. We suggest that disc degeneration is not an isolated event. It is rather a continuum of the events that could be clearly shown in the future prospective large-sample sized studies.

Journal Reference