Background Context The prevalence of lumbar spinal stenosis (LSS) in the general population and association with low back pain (LBP) remains unclear. Purpose 1) to evaluate the prevalence of congenital and acquired LSS observed on computed tomography (CT) in a community-based sample; 2) to evaluate the association between LSS and LBP. Study design/Setting Cross-sectional observational study. This study was an ancillary project to the Framingham Heart Study. Sample 3529 participants underwent multi-detector CT. 191 were enrolled in this study. Outcome Measures Self-report Measures LBP in the preceding 12 months was evaluated using a self-report questionnaire. Physiologic Measures LSS (congenital and acquired) was characterized using two cut-points: 12 mm for relative LSS, and 10 mm for absolute LSS. Methods Using multiple logistic regression we examined the association between LSS and LBP, adjusting for sex, age and BMI. Results In the congenital group, relative LSS was found in 4.7% and absolute LSS in 2.6% of patients. Acquired LSS was found in 22.5% and in 7.3%, respectively. Acquired LSS showed increasing prevalence with age: <40 years, the prevalence of relative and absolute LSS was 20.0% and 4.0%, respectively; in those 60–69 years the prevalence was 47.2% and 19.4%, respectively. The presence of absolute LSS was associated with LBP with an odds ratio of 3.16 (95% CI: 1.05–9.53). Conclusions The prevalence of congenital and acquired LSS in a community-based sample was characterized. The prevalence of acquired stenosis increased with age. LSS is associated with a three-fold higher risk of experiencing LBP.

Study Design Cross-sectional study. Objective To evaluate the association between lumbar spine facet joint osteoarthritis (FJ OA) identified by multi-detector computed tomography (CT) and low back pain (LBP) in the community-based Framingham Heart Study. Summary of Background Data The association between lumbar FJ OA and LBP remains unclear. Methods This study was an ancillary project to the Framingham Heart Study. A sample of 3529 participants of the Framingham Heart Study aged 40–80 underwent multi-detector CT imaging to assess aortic calcification. One hundred eighty-eight individuals were consecutively enrolled in this ancillary study to assess radiographic features associated with LBP. LBP in the preceding 12 months was evaluated using a self-report questionnaire. FJ OA was evaluated on CT scans using a 4-grade scale. The association between FJ OA and LBP was examined used multiple logistic regression models, while adjusting for gender, age and BMI. Results CT imaging revealed a high prevalence of FJ OA (59.6% of males and 66.7% of females). Prevalence of FJ OA increases with age. By decade, FJ OA was present in 24.0% of <40-years-olds, 44.7% of 40–49-years-olds, 74.2% of 50–59-years-olds, 89.2% of 60–69-years-olds, and 69.2% of >70-years-olds. By spinal level the prevalence of FJ OA was: 15.1% at L2–L3, 30.6% at L3–L4, 45.1% at L4–L5 and 38.2% at L5-S1. In this community-based population, individuals with FJ OA at any spinal level showed no association with LBP. Conclusions There is a high prevalence of FJ OA in the community. Prevalence of FJ OA increases with age with the highest prevalence at the L4–L5 spinal level. At low spinal levels women have a higher prevalence of lumbar FJ OA than men. In the present study we failed to find an association between FJ OA, identified by multi-detector CT, at any spinal level and LBP in a community-based study population.

This narrative review investigated imaging parameters of the paraspinal muscles and their association with spinal degenerative features and low back pain (LBP) found in the literature. Three principal signs of muscle degeneration were detected on imaging: decreased muscle size, decreased radiographic density, and increased fat deposits. Men have a higher density of paraspinal muscles than women, younger individuals have a higher density than older ones, and lean individuals have a higher density than those with an increased body mass index. Fatty infiltration appears to be a late stage of muscular degeneration and can be measured noninvasively by an MRI scan. Fatty infiltration in the lumbar multifidus is common in adults and is strongly associated with LBP, especially in women, independent of body composition. Fatty infiltration develops in areas where most degenerative changes are found. MR spectroscopy studies have corroborated that the lumbar multifidus in LBP subjects has a significantly higher fat content than asymptomatic controls. There is a strong need for establishing uniform methods of evaluating normal parameters and degenerative changes of the paraspinal muscles. Additional imaging studies are needed to improve the understanding of the association and causal relationships between LBP, spinal degeneration, and changes in the paraspinal muscles.

Background Context-The prevalence of lumbar spinal stenosis (LSS) in the general population and association with low back pain (LBP) remains unclear. Purpose-1) to evaluate the prevalence of congenital and acquired LSS observed on computed tomography (CT) in a community-based sample; 2) to evaluate the association between LSS and LBP. Study design/Setting-Cross-sectional observational study. This study was an ancillary project to the Framingham Heart Study. Sample-3529 participants underwent multi-detector CT. 191 were enrolled in this study. Self-report Measures-LBP in the preceding 12 months was evaluated using a self-report questionnaire. Physiologic Measures-LSS (congenital and acquired) was characterized using two cutpoints: 12 mm for relative LSS, and 10 mm for absolute LSS. Methods-Using multiple logistic regression we examined the association between LSS and LBP, adjusting for sex, age and BMI. Results-In the congenital group, relative LSS was found in 4.7% and absolute LSS in 2.6% of patients. Acquired LSS was found in 22.5% and in 7.3%, respectively. Acquired LSS showed increasing prevalence with age: <40 years, the prevalence of relative and absolute LSS was 20.0% and 4.0%, respectively; in those 60-69 years the prevalence was 47.2% and 19.4%, respectively. The presence of absolute LSS was associated with LBP with an odds ratio of 3.16 (95% CI: 1.05-9.53).

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