Back pain is among the most common conditions for which patients seek medical care. Interventions based on behavioral and cognitive principles and exercise programs are effective in improving disability in chronic back pain. Although progress has been made in understanding the role of genetic mutations in disorders such as lumbar disc disease, further investigation of the interaction between genetic and environmental factors such as physical stress is needed.

Initial retrospective assessment suggests that dual-energy CT is a sensitive, noninvasive, and reproducible method for identifying uric acid deposits in joints and periarticular soft tissues in patients suspected of having gout.

Objective. Few data exist concerning the natural history of lumbar spine disc degeneration and associated risk factors. We therefore undertook this study to examine the radiographic progression of lumbar spine disc degeneration over the course of 9 years in a population-based inception cohort of women from the Chingford Study.Methods. Seven hundred ninety-six paired lumbar spine radiographs were read by a single reader for anterior osteophytes (AO) and disc space narrowing (DSN) using the Lane atlas at each lumbar disc space (L1-5). Disc degeneration was defined using thresholds of AO and DSN grade 1؉ in one or more vertebrae (L1-5) within a subject. Progression was defined as an increase in grade in an affected year-1 vertebra. Potential risk factors were assessed using odds ratios and 95% confidence intervals adjusted for age, body mass index (BMI), and other potential confounders in logistic regression models using the STATA statistical package.Results. The mean ؎ SD age at baseline was 53.8 ؎ 6.0 years, and mean ؎ SD BMI was 25.4 ؎ 4.1 kg/m 2 . Progression rates for AO and DSN were 4% per annum and 3% per annum, respectively. Progression of DSN was predicted by age, back pain, and radiographic hip and knee osteoarthritis (OA). Progression of AO was predicted by age and radiographic hip OA, with borderline significance for BMI >30 kg/m 2 . No significant effects were seen for smoking, physical activity, hormone replacement therapy use, multiparity, or hand OA.Conclusion. This is the first population-based longitudinal study to assess progression of the individual radiographic features of AO and DSN in lumbar spine disc degeneration. We demonstrated progression rates of 3-4% per annum, with important risk factors for progression, including age, back pain, and radiographic OA at the hip and knee.Lumbar spine disc degeneration is characterized by disc space narrowing (DSN) and the presence of anterior vertebral osteophytes (AO). There is no consensus as to whether this is a form of osteoarthritis (OA) or a separate phenomenon, although lumbar spine disc degeneration is often labeled spinal OA and included in studies as a component of radiographic OA (1-3). There is a marked paucity of epidemiologic and populationbased data on disc degeneration. Investigators in crosssectional studies have reported similar prevalence rates increasing with age (2,4-6). Ethnic and sex differences have been demonstrated in some studies (2), and two recent magnetic resonance imaging (MRI) studies have shown the importance of genetic factors (7,8).Investigators in a number of studies have reported risk factor associations for prevalent disc degeneration. These risk factors include body mass index (BMI), back pain, occupational exposures, and heavy physical activity; however, the results are inconsistent (2,5,9,10). No clear association has been demonstrated with smoking, alcohol consumption, and hormone replacement therapy use. These results are likely to be limited by potential biases related to selection and consequences of the dise...

Objective. Schmorl's nodes (SN) are common, but little is known of their relationship with degenerative change and back pain or genetic and environmental factors influencing their expression. We studied healthy female twin volunteers to determine the prevalence and clinical features associated with SN. Methods. Serial sagittal T1-and T2-weighted magnetic resonance images of the lower thoracic and lumbar spine were analyzed in 516 healthy female twins (150 monozygotic and 366 dizygotic). The images were scored for lumbar degenerative change. Presence of SN was noted at cranial and caudal vertebral levels T9 to L5. Data on physical activity and back pain were collected by questionnaire. Heritability of SN was calculated using variance components modeling. Results. SN were found in 30% of subjects. Of the 374 SN, 153 (41%) were in the lumbar spine and 221 (59%) were in the thoracic spine. SN heritability was >70%. There was a positive association between SN and lumbar disc disease (LDD). SN were more frequent in subjects with back pain (for >2 SN: odds ratio [OR] 2.68, 95% confidence interval [95% CI] 1.11-6.47, P ‫؍‬ 0.03), but this was largely accounted for by the association of SN with LDD (OR 1.97, 95% CI 0.78 -5.0, P ‫؍‬ 0.15 adjusted for LDD). No independent association of SN with back pain was identified. Conclusion. SN are common in middle-aged women and are strongly genetically determined. They are associated with lumbar degenerative change, which is a risk factor for back pain, but are not themselves an independent risk factor for back pain.