Goal of the Study?
Disc degeneration (DD) is associated with ageing. However, DD is not always associated with lower back pain. This ISSLS Prize-Winning 2022 study1 looked at DD from childhood to adulthood to learn more about the natural history and see if it was related to clinical lower back pain.
Why are they doing this study?
Identifying the source(s) of lower back pain can be tricky to find, with many pathoanatomical findings found on MRI not correlating directly to lower back pain. Researchers have uncovered how a disc herniation is related to DD; however, Modic 1 changes did not appear to connect with the advancement of degenerative changes. Further evidence has also shed light on the association of lower back pain to certain MRI disc findings. In particular:
- disc degeneration
- disc protrusion
- disc bulge
- disc extrusion
On the other hand, high-intensity zones, like that seen in the outer annulus, have proven inconsistent with lower back pain. There have also been inconsistencies in predicting the onset of lower back pain with MRI findings. Understanding the natural history of disc degeneration is paramount in unravelling the relationship between pathoanatomical changes and lower back pain. These researchers sought to find more information.
What was done?
Starting in 1994, ninety-four healthy 8-year-old children were randomly selected from six primary schools in and around Helsinki, Finland. The children were examined at four time points: at the age of 8, 11, 18 and 34. All four time points included a clinical examination and a lumbar MRI. At the fourth and final time point, the subjects filled out a patient-reported outcome measure to determine a multitude of outcomes, including the most important—clinical low back pain.
What did they find?
The researchers found subjects with higher levels of degeneration at the age of 18 were more likely to have clinically relevant lower back pain at the age of 34.
Interestingly they found that those with lower back pain at 18 years of age were more likely to have lower back pain at 34 years of age. Furthermore, some who did not have back pain at 18 years of age reported back pain at 34 years.
Why do these findings matter?
Early detection of degenerative changes in the youth can be a cue to low back pain problems that develop later in life. Learning to identify these changes may be an important step in curtailing the greatest causes of global disability 2
At Dynamic Disc Designs, we have developed models to showcase early degenerative disc changes to help reveal the sources and causes of lower back pain. Patient education has been shown to be an important intervention in low back pain management.
- Accelerated disc degeneration after pubertal growth spurt differentiates adults with low back pain from their asymptomatic peers ↩
- GBD (2019) Diseases and Injuries Collaborators (2020) Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 396:1204–1222 ↩