Significance of the Association between Disc Degeneration Changes on Imaging and Low Back Pain: A Review Article

Abstract

Low back pain (LBP) is a major health issue resulting in a huge economic burden on the community. It not only increases the medical costs directly, but also raises the disability and loss of productivity in the general population. Symptoms include local pain over the spinal area, pain radiating to the lower leg, stiffness, and muscle tension. LBP is strongly linked with intervertebral disc degeneration that is further associated with the disruption of the complex anatomy of nucleus pulposus, annulus fibrosus, and adjacent supporting structures of the spine. Change in the shape and intensity of nucleus pulposus, decreased disc height, disc herniation, vertebral endplate changes, presence of osteophyte, and posterior high intensity zones are degenerative changes found in imaging studies. Every feature is considered while grading the severity score. Modic changes, DEBIT (disc extension beyond interspace) score, and Pfirrmann criteria are some of the scoring criteria used for evaluating disc degeneration severity. Moreover, the total number and contiguous pattern of affected discs play a crucial role in symptom generation of back pain. Many studies have reported asymptomatic patients. Thus, the correlation between degeneration severity found in imaging study and symptom severity of LBP remain unclear. This review discusses and summarizes the available literature on the significance of the association between the severity of degenerative changes found in imaging study with the presence and intensity of LBP.

Severity of intervertebral disc herniation regulates cytokine and chemokine levels in patients with chronic radicular back pain

“…Interestingly, these significant relationships between DH severity and cytokine levels were present in subjects with chronic symptoms, but did not hold for those with acute symptoms. Not surprisingly, we did not observe significant differences in serum cytokines with respect to disease severity as classified by Pfirrmann grade, consistent with prior findings 25,29 . Indeed, MRI signal grading of degeneration does not correlate to functional impairment or pain 30 .…”

Lumbar disc herniation surgery in adolescents and young adults

“…The evidence for the presence of Modic changes as an association to low back pain is conflicting (11,(209)(210)(211)(212)(213)(214). Two reviews have found Modic type 1 changes to be relatively correlated to low back pain (211,212). Modic type 1 was also observed in a larger proportion at level L4-L5 and particularly level L5-S1 among the cases compared to controls.…”

Modic changes - An evidence-based, narrative review on its patho-physiology, clinical significance and role in chronic low back pain

“…6 With the advent of MRI, the complex relationship between disc, vertebral body, end plates and facet joints; as well as their individual roles in the pathogenesis of LBP have received tremendous attention. 7 The disc is avascular with sparse nerve distribution and lacks a strong physiological basis as a primary pain generator. 8 Over years, the attention has therefore shifted to other anatomical structures like endplates to explain the etiological basis of LBP.…”