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Article: Are "patterns" of lumbar disc degeneration associated with low back pain?: New insights based on skipped level disc pathology

TitleAre "patterns" of lumbar disc degeneration associated with low back pain?: New insights based on skipped level disc pathology
Authors
Keywordsclassifi cation
clinical
degenerative
disc
low back pain
lumbar
nonconsecutive
skipped
symptoms
Issue Date2012
PublisherLippincott, Williams & Wilkins. The Journal's web site is located at http://www.spinejournal.com
Citation
Spine, 2012, v. 37 n. 7, p. E430-E438 How to Cite?
AbstractSTUDY DESIGN.: A cross-sectional, population-based cohort study. OBJECTIVE.: The objective of this study was to evaluate the clinical relevance of skipped level disc degeneration (SLDD) to that of contiguous, multilevel disc degeneration (CMDD) of the lumbar spine. The study also aimed to identify patterns of SLDD, its classification, prevalence, and clinical relevance. SUMMARY OF BACKGROUND DATA.: The association of disc degeneration on magnetic resonance imaging with low back pain (LBP) remains questionable. The occurrence of SLDD of the lumbar spine has recently been noted. To date, patterns of disc degeneration have been overlooked in the association with low back symptoms. METHODS.: A population-based radiographic and clinical study of 3099 Southern Chinese patients. Individuals with multilevel disc degeneration of the lumbar spine on sagittal T2-weighted magnetic resonance imaging (N = 1457) were stratified to SLDD (n = 301; 20.7%) or CMDD (n = 1156; 79.3%) groups. SLDD was further classified into 5 types by the relative location of nondegenerated normal disc(s) to degenerated disc levels. Subject demographics, presence of LBP, pain intensity, and functional disability were assessed. RESULTS.: In the multivariate analyses, CMDD increased the likelihood of historical LBP (odds ratio [OR]: 1.39; 95% confidence interval [CI]: 1.00-1.93; P = 0.047) and pain severity (OR: 1.83; 95% CI: 1.23-2.73; P = 0.003) in comparison with SLDD. A significant increasing trend of number of levels with disc degeneration, overall disc degeneration severity, and presence of disc bulges/extrusions was noted from SLDD type I (least severe) to SLDD type V (most severe) (P < 0.05). A higher prevalence of LBP and a higher pain intensity were observed in SLDD classification type V. Functional disability scores did not differ between CMDD and SLDD, nor within SLDD classification types (P > 0.05). CONCLUSION.: Our large-scale study is the first to describe novel variants of SLDD types and their clinical relevance. More important, LBP and severity of pain were more pronounced in individuals with CMDD rather than those with SLDD. Our study suggests that subjects with a similar degree but different patterns of multilevel disc degeneration do differ with respect to low back symptoms. This finding may provide new evidence with regard to the mechanism of LBP. © 2012, Lippincott Williams & Wilkins.
Persistent Identifierhttp://hdl.handle.net/10722/137442
ISSN
2015 Impact Factor: 2.439
2015 SCImago Journal Rankings: 1.459
ISI Accession Number ID
Funding AgencyGrant Number
Area of Excellence Program of Hong KongAoE/M-04/04
Funding Information:

Area of Excellence Program of Hong Kong funds were received to support this work.

References
Grants

 

DC FieldValueLanguage
dc.contributor.authorCheung, KMCen_HK
dc.contributor.authorSamartzis, Den_HK
dc.contributor.authorKarppinen, Jen_HK
dc.contributor.authorLuk, KDKen_HK
dc.date.accessioned2011-08-26T14:25:11Z-
dc.date.available2011-08-26T14:25:11Z-
dc.date.issued2012en_HK
dc.identifier.citationSpine, 2012, v. 37 n. 7, p. E430-E438en_HK
dc.identifier.issn0362-2436en_HK
dc.identifier.urihttp://hdl.handle.net/10722/137442-
dc.description.abstractSTUDY DESIGN.: A cross-sectional, population-based cohort study. OBJECTIVE.: The objective of this study was to evaluate the clinical relevance of skipped level disc degeneration (SLDD) to that of contiguous, multilevel disc degeneration (CMDD) of the lumbar spine. The study also aimed to identify patterns of SLDD, its classification, prevalence, and clinical relevance. SUMMARY OF BACKGROUND DATA.: The association of disc degeneration on magnetic resonance imaging with low back pain (LBP) remains questionable. The occurrence of SLDD of the lumbar spine has recently been noted. To date, patterns of disc degeneration have been overlooked in the association with low back symptoms. METHODS.: A population-based radiographic and clinical study of 3099 Southern Chinese patients. Individuals with multilevel disc degeneration of the lumbar spine on sagittal T2-weighted magnetic resonance imaging (N = 1457) were stratified to SLDD (n = 301; 20.7%) or CMDD (n = 1156; 79.3%) groups. SLDD was further classified into 5 types by the relative location of nondegenerated normal disc(s) to degenerated disc levels. Subject demographics, presence of LBP, pain intensity, and functional disability were assessed. RESULTS.: In the multivariate analyses, CMDD increased the likelihood of historical LBP (odds ratio [OR]: 1.39; 95% confidence interval [CI]: 1.00-1.93; P = 0.047) and pain severity (OR: 1.83; 95% CI: 1.23-2.73; P = 0.003) in comparison with SLDD. A significant increasing trend of number of levels with disc degeneration, overall disc degeneration severity, and presence of disc bulges/extrusions was noted from SLDD type I (least severe) to SLDD type V (most severe) (P < 0.05). A higher prevalence of LBP and a higher pain intensity were observed in SLDD classification type V. Functional disability scores did not differ between CMDD and SLDD, nor within SLDD classification types (P > 0.05). CONCLUSION.: Our large-scale study is the first to describe novel variants of SLDD types and their clinical relevance. More important, LBP and severity of pain were more pronounced in individuals with CMDD rather than those with SLDD. Our study suggests that subjects with a similar degree but different patterns of multilevel disc degeneration do differ with respect to low back symptoms. This finding may provide new evidence with regard to the mechanism of LBP. © 2012, Lippincott Williams & Wilkins.en_HK
dc.languageengen_US
dc.publisherLippincott, Williams & Wilkins. The Journal's web site is located at http://www.spinejournal.comen_HK
dc.relation.ispartofSpineen_HK
dc.rightsThis is a non-final version of an article published in final form in (Spine, 2012, v. 37 n. 7, p. E430-E438)-
dc.subjectclassifi cationen_HK
dc.subjectclinicalen_HK
dc.subjectdegenerativeen_HK
dc.subjectdiscen_HK
dc.subjectlow back painen_HK
dc.subjectlumbaren_HK
dc.subjectnonconsecutiveen_HK
dc.subjectskippeden_HK
dc.subjectsymptomsen_HK
dc.titleAre "patterns" of lumbar disc degeneration associated with low back pain?: New insights based on skipped level disc pathologyen_HK
dc.typeArticleen_HK
dc.identifier.emailCheung, KMC:cheungmc@hku.hken_HK
dc.identifier.authorityCheung, KMC=rp00387en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1097/BRS.0b013e3182304dfcen_HK
dc.identifier.pmid22466575-
dc.identifier.scopuseid_2-s2.0-84859355654en_HK
dc.identifier.hkuros189125en_US
dc.identifier.hkuros208411-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-84859355654&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume37en_HK
dc.identifier.issue7en_HK
dc.identifier.spageE430en_HK
dc.identifier.epageE438en_HK
dc.identifier.isiWOS:000302266400003-
dc.publisher.placeUnited Statesen_HK
dc.relation.projectDevelopmental genomics and skeletal research-
dc.identifier.scopusauthoridCheung, KMC=7402406754en_HK
dc.identifier.scopusauthoridSamartzis, D=55171428200en_HK
dc.identifier.scopusauthoridKarppinen, J=7004560479en_HK
dc.identifier.scopusauthoridLuk, KDK=55171413200en_HK

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