An association which becomes nonsignificant when endplate changes and disc contour are taken into account

Francisco M. Kovacs
Neuroradiology:  November 2013

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.

Journal Abstract:  http://link.springer.com/article/10.1007%2Fs00234-013-1294-y