Osteoarthritis (OA) of the spine involves the facet joints, which are located in the posterior aspect of the vertebral column and, in humans, are the only true synovial joints between adjacent spinal levels. Facet joint osteoarthritis (FJ OA) is widely prevalent in older adults, and is thought to be a common cause of back and neck pain. The prevalence of facet-mediated pain in clinical populations increases with increasing age, suggesting that FJ OA might have a particularly important role in older adults with spinal pain. Nevertheless, to date FJ OA has received far less study than other important OA phenotypes such as knee OA, and other features of spine pathoanatomy such as degenerative disc disease. This Review presents the current state of knowledge of FJ OA, including relevant anatomy, biomechanics, epidemiology, and clinical manifestations. We present the view that the modern concept of FJ OA is consonant with the concept of OA as a failure of the whole joint, and not simply of facet joint cartilage.

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.

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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Osteoarthritis (OA) is the most common cause of walking-related disability among older adults in the United States, and the prevalence and incidence of OA are increasing rapidly. Systemic and local risk factors for knee OA have been identified, and obesity and joint injury appear to be the strongest risk factors that are both modifiable and have the potential for substantial impact on a population level. The risk factors for functional decline and disability in persons with symptomatic OA have been examined in relatively few studies. The course of functional decline in persons with symptomatic OA on a population level is generally one of stable to slowly deteriorating function, but on an individual level, many patients maintain function or improve during the first 3 years of follow-up. Obesity stands out as one of few modifiable risk factors of OA that also is a potentially modifiable predictor of functional decline. Physical activity also appears to have a substantial protective impact on future OA-related disability. Further epidemiologic studies and randomized controlled trials are needed to prioritize prevention through targeting these modifiable risk factors for OA and related disability.

Back pain (BP) is a common condition of major social importance and poorly understood pathogenesis. Combining data from the UK Biobank and CHARGE consortium cohorts allowed us to perform a very large GWAS (total N = 509,070) and examine the genetic correlation and pleiotropy between BP and its clinical and psychosocial risk factors. We identified and replicated three BP associated loci, including one novel region implicating SPOCK2/CHST3 genes. We provide evidence for pleiotropic effects of genetic factors underlying BP, height, and intervertebral disc problems. We also identified independent genetic correlations between BP and depression symptoms, neuroticism, sleep disturbance, overweight, and smoking. A significant enrichment for genes involved in central nervous system and skeletal tissue development was observed. The study of pleiotropy and genetic correlations, supported by the pathway analysis, suggests at least two strong molecular axes of BP genesis, one related to structural/anatomic factors such as intervertebral disk problems and anthropometrics; and another related to the psychological # Corresponding author. * These authors contributed equally to this work. AUTHOR CONTRIBUTIONS MF and YT contributed to the design of the study, carried out statistical analysis, produced the figures, and first draft of the manuscript; LC provided statistical and computational support; MP and PS analysed CHARGE dataset and contributed to interpretation of the results; YA and FW conceived and oversaw the study, contributed to the design and interpretation of the results; all co-authors contributed to the final manuscript revision. COMPETING FINANCIAL INTERESTS YSA and LCK are owners of Maatschap PolyOmica, a private organization, providing services, research and development in the field of computational and statistical (gen)omics. Other authors declare no conflicts of interest.

Objective To determine if trunk muscle attributes are associated with balance and mobility performance among mobility-limited older adults. Design Cross-sectional analysis of data from a randomized clinical trial. Setting Outpatient rehabilitation research center. Participants Community-dwelling older adults (N=70; mean age 75.9 y) with mobility limitations as defined by the Short Physical Performance Battery (SPPB). Methods Independent variables included physiologic measures of trunk extension strength, trunk flexion strength, trunk extension endurance, trunk extension endurance and leg press strength. All measures were well tolerated by the study subjects without the occurrence of any associated injuries or adverse events. The association of each physiologic measure with each outcome was examined, using separate multivariate models to calculate the partial variance (R2) of each trunk and extremity measure. Main Outcome Measurements Balance measured by the Berg Balance Scale (BBS) and Unipedal Stance Test (UST), and mobility performance as measured by the SPPB. Results Trunk extension endurance (partial R2=.14, p=.02), and leg press strength (partial R2=.14, p=.003) accounted for the greatest amount of the variance in SPPB performance. Trunk extension endurance (partial R2=.17, p=.007), accounted for the greatest amount of the variance in BBS performance. Trunk extension strength (R2=.09, p=.03), accounted for the greatest amount of the variance in UST performance. The variance explained by trunk extension endurance equaled or exceeded the variance explained by limb strength across all three performance outcomes. Conclusions Trunk endurance and strength can be safely measured in mobility-limited older adults, and are associated with both balance and mobility performance. Trunk endurance and trunk strength are physiologic attributes worthy of targeting in the rehabilitative care of mobility-limited older adults.

Objective. To examine the association of concurrent low back pain (LBP), and other musculoskeletal pain comorbidity, with knee pain severity in symptomatic knee osteoarthritis (OA). Methods. Individuals from the Progression