Disc degeneration and chronic low back pain: an association which becomes nonsignificant when endplate changes and disc contour are taken into account

Kovacs, Francisco M.; Arana, Estanislao; Royuela, Ana; Estremera, Ana; Amengual, Guillermo; Asenjo, Beatriz; Sarasíbar, H.; Galarraga, Isabel; Alonso, Ana; Casillas, Carlos; Muriel, Alfonso; Martı́nez, Carmen Enid; Abraira, Víctor

doi:10.1007/s00234-013-1294-y

Cited by 22 publications

(17 citation statements)

References 31 publications

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“…Understanding the root cause of pain from degeneration is difficult due to a high prevalence of asymptomatic individuals with disc degeneration. 17 In contrast, pain caused by a herniated disc may be easier to identify as the protruding material impinges on spinal nerves, resulting in low back pain and/or sciatica (i.e., radiating leg pain).…”

Section: Introductionmentioning

confidence: 99%

Tissue Engineering a Biological Repair Strategy for Lumbar Disc Herniation

O’Connell

Leach

Klineberg

2015

BioResearch Open Access

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The intervertebral disc is a critical part of the intersegmental soft tissue of the spinal column, providing flexibility and mobility, while absorbing large complex loads. Spinal disease, including disc herniation and degeneration, may be a significant contributor to low back pain. Clinically, disc herniations are treated with both nonoperative and operative methods. Operative treatment for disc herniation includes removal of the herniated material when neural compression occurs. While this strategy may have short-term advantages over nonoperative methods, the remaining disc material is not addressed and surgery for mild degeneration may have limited long-term advantage over nonoperative methods. Furthermore, disc herniation and surgery significantly alter the mechanical function of the disc joint, which may contribute to progression of degeneration in surrounding tissues. We reviewed recent advances in tissue engineering and regenerative medicine strategies that may have a significant impact on disc herniation repair. Our review on tissue engineering strategies focuses on cell-based and inductive methods, each commonly combined with material-based approaches. An ideal clinically relevant biological repair strategy will significantly reduce pain and repair and restore flexibility and motion of the spine.

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Section: Introductionmentioning

confidence: 99%

Tissue Engineering a Biological Repair Strategy for Lumbar Disc Herniation

O’Connell

Leach

Klineberg

2015

BioResearch Open Access

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“…Lumber disc degeneration is a potential cause of low back pain (LBP). Though disc degeneration itself is not diagnostic for LBP (1)(2)(3)(4), in a recent meta-analysis for adults 50 years of age or younger, Brinjikji et al (5) reported disc degeneration is associated with LBP (OR, 2.24; 95% CI, 1.21-4.15; P=0.01). Many studies on magnetic resonance (MR) relaxometry and disc degeneration have been published (6)(7)(8).…”

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confidence: 99%

Towards consistency for magnetic resonance (MR) relaxometry of lumbar intervertebral discs

Wáng

2016

Quant. Imaging Med. Surg.

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“…The association between MCs and LBP has previously been examined in studies with 1-2 year follow-up and one study with 10-year follow-up 17 . Some studies have reported a higher prevalence of LBP in patients with MCs, particularly MC-1, compared to DD alone, while other studies do not find MCs to be associated with LBP [11][12][13]15,16,26 . A systematic review and meta-analysis from 2018 of 31 MCs studies, found the association between MCs and LBPrelated outcomes to be inconsistent 10 .…”

Section: None Of the Patients Had Prolonged Courses Of Antibiotics Aimentioning

confidence: 98%

“…Of the subjects with MCs, 88% reported pain in the past year, compared to 63% of those without MCs. Although back pain and disability have been associated with MC in several studies, the results are still conflicting [10][11][12][13][14][15][16] . The currently available studies are predominantly either crosssectional or with short follow-up, and only one looked at long-term influences 17 .…”

Section: Introductionmentioning

confidence: 99%

Modic Changes Are Not Associated With Long-term Pain and Disability

Udby¹,

Bendix

Ohrt-Nissen³

et al. 2019

Spine

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Study Design: A comparative cohort study with 13-year follow-up. Objective: To assess whether Modic Changes (MCs) are associated with long-term physical disability, back pain and sick leave. Summary of Background Data: Previous studies have shown a conflicting association of low back pain (LBP) with MCs and disc degeneration. The long-term prognosis of patients with MCs is unclear. Methods: In 2004-2005, patients aged 18-60 with daily LBP were enrolled in an RCT study and lumbar MRI was performed. Patients completed numeric rating scales (NRS, 0-10) for LBP and leg pain (LP), Roland-Morris Disability Questionnaire (RMDQ), LBP Rating Scale for activity limitations (RS, 0-30), Inflammatory pain pattern (IPP) and sick leave days due to LBP at baseline and 13-years after the MRI. Patients were stratified based on the presence (+MC) or absence (-MC) of MCs on the MRI. Results: Of 204 cases with baseline MRI, 170 (83%) were available for follow-up; 67 (39%) with MCs and 103 (61%) without MCs. Demographics, smoking status, BMI, use of antibiotics, LBP, LP and IPP scores at baseline and at 13-year follow-up were similar between the two groups. Also, baseline RMDQ was similar between the +MC and-MC groups. At 13 years, the RMDQ score was statistically significant better in the +MC group (7.4) compared to the-MC group (9.6, p=0.024). Sick leave days due to LBP were similar at baseline but less in the +MC group (9.0) compared to the-MC group (22.9 days, p=0.003) at 13 years. Conclusion: MCs were not found to be negatively associated with long-term pain, disability or sick leave. Rather, the study found that LBP patients with MCs had significantly less disability and sick-leave at long-term follow-up. We encourage further studies to elucidate these findings.

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Disc degeneration and chronic low back pain: an association which becomes nonsignificant when endplate changes and disc contour are taken into account

Abstract: 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.

Cited by 22 publications

References 31 publications

Tissue Engineering a Biological Repair Strategy for Lumbar Disc Herniation

Tissue Engineering a Biological Repair Strategy for Lumbar Disc Herniation

Towards consistency for magnetic resonance (MR) relaxometry of lumbar intervertebral discs

Modic Changes Are Not Associated With Long-term Pain and Disability

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