Impact of dyslipidemia on the severity of symptomatic lumbar spine degeneration: A retrospective clinical study

Abstract

BackgroundLumbar intervertebral disc degeneration (IVDD) is an important cause of low back pain or sciatica, and metabolic factors play an important role. However, little is known about the relationship of dyslipidemia to the risk of intervertebral disc degeneration (IVDD). This study aimed to assess the impact of serum lipid levels on the severity of lumbar disc degeneration and to investigate its association with endplate inflammation.MethodsWe conducted a case retrospective study in which a total of 302 hospitalized Chinese patients were recruited, of whom 188 (112 males and 76 females; mean age: 51.66 years) were without underlying disease, while the remaining 114 patients (51 males and 63 females; mean age: 62.75 years) had underlying diseases. We examined fasting serum lipid levels for total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C). Magnetic resonance imaging (MRI) was used to determine endplate inflammation. Pfirrmann grading and Weishaupt grading were used to evaluate the severity of intervertebral disc degeneration and facet joint degeneration, respectively.ResultsThere was no difference in age, gender, and general BMI between the two groups (P > 0.05), but there were significantly high levels in TC, LDL-C, and LDL-C/HDL-C (P = 0.04, P = 0.013, P = 0.01, respectively). TG and HDL-C showed no significant difference (P = 0.064, P = 0.336, respectively). The multivariate logistic regression model showed that age was a risk factor for the occurrence of endplate inflammation. In the group without underlying diseases, age, but not other indicators, was a risk factor for the occurrence of endplate inflammation (P < 0.01), In the group with underlying diseases, none of the patient indicators was directly related to the occurrence of endplate inflammation (P > 0.05). A nonlinear machine learning model was used to measure the contribution of each factor to the disease outcome and to analyze the effect between the top three contributing factors and the outcome variables. In patients without underlying diseases, the top three factors contributing to the severity grading of intervertebral disc degeneration were age (32.9%), high-density lipoproteins (20.7%), and triglycerides (11.8%). For the severity grading of facet joint degeneration, the top three contributing factors were age (27.7%), high-density lipoproteins (19.4%), and triglycerides (14.6%). For patients with underlying diseases, the top three factors contributing to intervertebral disc degeneration were age (25.4%), BMI (15.3%), and low-density lipoprotein/high-density lipoprotein ratio (13.9%). In terms of degree classification for facet joint degeneration, the top three contributing factors were age (17.5%), BMI (17.2%), and total cholesterol (16.7%).ConclusionThis study shows that age, high-density lipoprotein, and triglycerides affect the degree of degeneration in patients with symptomatic lumbar degeneration without underlying diseases. Age and BMI are two major factors affecting the severity of degeneration in patients with underlying diseases, and dyslipidemia is a secondary factor. However, there is no clear association between dyslipidemia and the occurrence of endplate inflammation in either group.

Dyslipidemia Is Positively Associated with Chronic Low Back Pain in Korean Women: Korean National Health and Nutrition Examination Survey 2010–2012

“…Based on the mechanism that CLBP can be caused by hypertension-induced aneurysms in the aorta adjacent to the lumbar region [ 7 ]. One study reported a positive relationship between hypertension and CLBP [ 11 ], another found a significant association between hypertension and severe CLBP [ 23 ], and an additional study reported a significantly increased risk of CLBP in a group of men with hypertension [ 13 ]. Based on the above, we assumed that there would be a positive relationship between hypertension and CLBP.…”

“…Yuan et al found that Chinese individuals with high TG ≥ 6.2 mg/dL (OR, 1.775; 95% CI, 1.209, 2.606) and high LDL ≥ 4.1 mmol/L (OR, 1.818; 95% CI, 1.123, 2.943) tended to have a higher risk of developing lumbar intervertebral disc degeneration, a known cause of LBP [ 22 ]. Similarly, a retrospective study of 320 Chinese patients and a case-control study of 105 Koreans by Haung et al found that higher total cholesterol and TG levels were associated with increased lumbar intervertebral disc degeneration and a significantly higher incidence of LBP [ 23 , 24 ]. A case-control study of 269 patients found an increased risk of intervertebral disc degeneration in the setting of dyslipidemia with high TG (OR, 1.753; 95% CI, 1.151, 2.699; p = 0.009), high LDL (OR, 1.952; 95% CI, 1.530, 2.490; p < 0.001), or high total cholesterol (OR, 3.580; 95% CI, 2.182, 55.876; p < 0.001).…”

“…Some studies have found a meaningful association between diabetes and CLBP [ 9 , 17 , 18 , 19 ], whereas others have reported no relationship [ 20 , 21 ]. Similarly, some studies have suggested a positive relationship between dyslipidemia and CLBP [ 10 , 22 , 23 , 24 , 25 ], whereas others have found no association between them [ 23 , 26 , 27 ]. Based on the results of these published studies, the association between CLBP and chronic diseases is still inconsistent.…”

Exploring the direct or mediating associations between lipids, atherosclerosis, obesity, and intervertebral disc degeneration: a Mendelian randomization study

“…Consistent with the results of our study, most studies have suggested that HDL is closely related to IVDD. A retrospective clinical study involving 302 patients found that the top two factors affecting the severity classi cation of IVDD were age (32.9%) and HDL (20.7%), and suggested that increased HDL levels may reduce the incidence of IVDD (5) . A similar conclusion was reached by another retrospective study including 790 patients, who found that the ratio of TC/HDL-C and LDL-C/HDL-C were signi cantly associated with lumbar disc herniation (LDH) (36).…”

“…Several studies have shown that lipid metabolism is closely related to IVDD (4). A retrospective case study including 302 patients showed that high-density lipoprotein (HDL) and triglyceride (TG) are important factors affecting the degree of intervertebral disc degeneration (5). An observational study found that high LDL levels was strongly associated with L4/5 disc degeneration (OR, 2.65) (6).…”