Predictors of Lumbar Spine Degeneration and Low Back Pain in the Community: The Johnston County Osteoarthritis Project

Abstract

Objective To determine the incidence and worsening of lumbar spine structure and low back pain (LBP) and whether they are predicted by demographic characteristics or clinical characteristics or appendicular joint osteoarthritis (OA). Methods Paired baseline (2003–2004) and follow‐up (2006–2010) lumbar spine radiographs from the Johnston County Osteoarthritis Project were graded for osteophytes (OST), disc space narrowing (DSN), spondylolisthesis, and presence of facet joint OA (FOA). Spine OA was defined as at least mild OST and mild DSN at the same level for any level of the lumbar spine. LBP, comorbidities, and back injury were self‐reported. Weibull models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) of spine phenotypes accounting for potential predictors including demographic characteristics, clinical characteristics, comorbidities, obesity, and appendicular OA. Results Obesity was a consistent and strong predictor of incidence of DSN (HR 1.80 [95% CI 1.09–2.98]), spine OA (HR 1.56 [95% CI 1.01–2.41]), FOA (HR 4.99 [95% CI 1.46–17.10]), spondylolisthesis (HR 1.87 [95% CI 1.02–3.43]), and LBP (HR 1.75 [95% CI 1.19–2.56]), and worsening of DSN (HR 1.51 [95% CI 1.09–2.09]) and LBP (HR 1.51 [95% CI 1.12–2.06]). Knee OA was a predictor of incident FOA (HR 4.18 [95% CI 1.44–12.2]). Spine OA (HR 1.80 [95% CI 1.24–2.63]) and OST (HR 1.85 [95% CI 1.02–3.36]) were predictors of incidence of LBP. Hip OA (HR 1.39 [95% CI 1.04–1.85]) and OST (HR 1.58 [95% CI 1.00–2.49]) were predictors of LBP worsening. Conclusion Among the multiple predictors of spine phenotypes, obesity was a common predictor for both incidence and worsening of lumbar spine degeneration and LBP.

Biomarker clusters differentiate phenotypes of lumbar spine degeneration and low back pain: The Johnston County Osteoarthritis Project

“…Participants were selected if they had complete lumbar spine radiographs (n = 819). Of those participants with complete paired lumbar spine readings, some participants (n = 74) had participated in a pilot study to understand the validity and reliability of the proposed biomarkers [ 6 ] and were therefore excluded. There were also some participants having missing covariate information (i.e., dolorimeter and pain measures, n = 14), leaving 731 participants available for this study.…”

“…Both DSN and OST were dichotomized as absent (none) or present (mild, moderate, or severe). Our prior analyses have examined different cut-offs for defining DSN and OST without any significant change in the findings [ 5 , 6 , 9 – 11 ]. The intra-rater reliability of this radiologist for the spine features has been reported previously with weighted kappa scores of 0.89 for DSN, 0.90 for OST, and 0.73 for FOA [ 10 ].…”

Classification of Osteophytes Occurring in the Lumbar Intervertebral Foramen

“…Low back pain is not observed in people without degenerative osteoarthritis, as confirmed through lumbar magnetic resonance images [ 7 ]. Obesity, lumbar disk degeneration, and spinal osteoarthritis contribute to spinal degeneration [ 8 ].…”

Characterizing Acute Low Back Pain in a Community-Based Cohort

“…Like studies of those seeking care for LBP, the limited US community-based studies available also indicate that chronic LBP incidence is higher than previously thought (approximately 25%). [25; 52]…”

“…Like studies of those seeking care for LBP, the limited US community-based studies available, also indicate that chronic LBP incidence is higher than previously thought (approximately 25%). 27,54 Various cutoffs for pain intensity (e.g., >4/10 on an 11-point scale) have been proposed to determine eligibility for LBP studies with the rationale that excluding individuals with lower pain intensity may provide greater scope for meaningful change in pain scores. 37 The downside is that studies applying such restrictions may miss important information regarding characteristics of the overall group of acute LBP sufferers, biasing study results and impacting the ability to estimate (and accurately predict) the incidence of chronic LBP transition.…”