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

다국어 초록 (Multilingual 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.

참고문헌 (Reference)

1 DePalma MJ, "What is the source of chronic low back pain and does age play a role?" 12 : 224-233, 2011

2 Jarvik JG, "Three-year incidence of low back pain in an initially asymptomatic cohort : clinical and imaging risk factors" 30 : 1541-1548, 2005

3 Hadjipavlou AG, "The pathophysiology of disc degeneration : a critical review" 90 : 1261-1270, 2008

4 Edgar MA, "The nerve supply of the lumbar intervertebral disc" 89 : 1135-1139, 2007

5 De Schepper EI, "The association between lumbar disc degeneration and low back pain : the influence of age, gender, and individual radiographic features" 35 : 531-536, 2010

6 Jarvik JJ, "The Longitudinal Assessment of Imaging and Disability of the Back(LAIDBack)Study : baseline data" 26 : 1158-1166, 2001

7 Hancock MJ, "Systematic review of tests to identify the disc, SIJ or facet joint as the source of low back pain" 16 : 1539-1550, 2007

8 Brinjikji W, "Systematic literature review of imaging features of spinal degeneration in asymptomatic populations" 36 : 811-816, 2015

9 Hassett G, "Risk factors for progression of lumbar spine disc degeneration : the Chingford Study" 48 : 3112-3117, 2003

10 Kettler A, "Review of existing grading systems for cervical or lumbar disc and facet joint degeneration" 15 : 705-718, 2006

11 Lane NE, "Reliability of new indices of radiographic osteoarthritis of the hand and hip and lumbar disc degeneration" 20 : 1911-1918, 1993

12 Pye SR, "Radiographic features of lumbar disc degeneration and self-reported back pain" 31 : 753-758, 2004

13 Cheung KM, "Prevalence and pattern of lumbar magnetic resonance imaging changes in a population study of one thousand fortythree individuals" 34 : 934-940, 2009

14 Teraguchi M, "Prevalence and distribution of intervertebral disc degeneration over the entire spine in a populationbased cohort : the Wakayama Spine Study" 22 : 104-110, 2014

15 Mooney V, "Presidential address. International Society for the Study of the Lumbar Spine. Dallas, 1986. Where is the pain coming from?" 12 : 754-759, 1987

16 Mostagi FQ, "Pilates versus general exercise effectiveness on pain and functionality in non-specific chronic low back pain subjects" 19 : 636-645, 2015

17 Peng BG, "Pathophysiology, diagnosis, and treatment of discogenic low back pain" 4 : 42-52, 2013

18 Vucetic N, "Pain and pathology in lumbar disc hernia" (320) : 65-72, 1995

19 Balague F, "Nonspecific low back pain" 379 : 482-491, 2012

20 Fardon DF, "Nomenclature and classification of lumbar disc pathology: recommendations of the combined task forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology" 26 : E93-E113, 2001

21 Visuri T, "Narrowing of lumbar spinal canal predicts chronic low back pain more accurately than intervertebral disc degeneration : a magnetic resonance imaging study in young Finnish male conscripts" 170 : 926-930, 2005

22 Thompson KJ, "Modic changes on MR images as studied with provocative diskography : clinical relevance : a retrospective study of 2457 disks" 250 : 849-855, 2009

23 Allegri M, "Mechanisms of low back pain: a guide for diagnosis and therapy:version 2; peer review: 3 approved" 5 : 1530-, 2016

24 Ito K, "Mechanisms of intervertebral disk degeneration/injury and pain : a review" 3 : 145-152, 2013

25 Pearce RH, "Magnetic resonance imaging reflects the chemical changes of aging degeneration in the human intervertebral disk" 27 : 42-43, 1991

26 Jensen MC, "Magnetic resonance imaging of the lumbar spine in people without back pain" 331 : 69-73, 1994

27 Greenberg JO, "Magnetic resonance imaging of the lumbar spine in asymptomatic adults : cooperative study : American Society of Neuroimaging" 1 : 2-7, 1991

28 Kjaer P, "Magnetic resonance imaging and low back pain in adults : a diagnostic imaging study of 40-year-old men and women" 30 : 1173-1180, 2005

29 Pfirrmann CW, "Magnetic resonance classification of lumbar intervertebral disc degeneration" 26 : 1873-1878, 2001

30 Katz JN, "Lumbar disc disorders and low-back pain : socioeconomic factors and consequences" 88 (88): 21-24, 2006

31 Saleem S, "Lumbar disc degenerative disease : disc degeneration symptoms and magnetic resonance image findings" 7 : 322-334, 2013

32 Luoma K, "Low back pain in relation to lumbar disc degeneration" 25 : 487-492, 2000

33 Mitra D, "Longitudinal study of high intensity zones on MR of lumbar intervertebral discs" 59 : 1002-1008, 2004

34 Kirkaldy-Willis WH, "Instability of the lumbar spine" (165) : 110-123, 1982

35 Chou R, "Imaging strategies for low-back pain : systematic review and metaanalysis" 373 : 463-472, 2009

36 Sasiadek MJ, "Imaging of degenerative spine disease : the state of the art" 21 : 133-142, 2012

37 Modic MT, "Imaging of degenerative disk disease" 168 : 177-186, 1988

38 Fagan A, "ISSLS prize winner : the innervation of the intervertebral disc : a quantitative analysis" 28 : 2570-2576, 2003

39 Roberts S, "Histology and pathology of the human intervertebral disc" 88 (88): 10-14, 2006

40 Andersson GB, "Epidemiological features of chronic low-back pain" 354 : 581-585, 1999

41 Steffens D, "Does magnetic resonance imaging predict future low back pain? : a systematic review" 18 : 755-765, 2014

42 Takatalo J, "Does lumbar disc degeneration on magnetic resonance imaging associate with low back symptom severity in young Finnish adults?" 36 : 2180-2189, 2011

43 Berg L, "Do more MRI findings imply worse disability or more intense low back pain? : a cross-sectional study of candidates for lumbar disc prosthesis" 42 : 1593-1602, 2013

44 Kettler A, "Do early stages of lumbar intervertebral disc degeneration really cause instability? : evaluation of an in vitro database" 20 : 578-584, 2011

45 Lim CH, "Discogenic lumbar pain : association with MR imaging and CT discography" 54 : 431-437, 2005

46 Chou D, "Degenerative magnetic resonance imaging changes in patients with chronic low back pain : a systematic review" 36 (36): S43-S53, 2011

47 Modic MT, "Degenerative disk disease : assessment of changes in vertebral body marrow with MR imaging" 166 (166): 193-199, 1988

48 Kanayama M, "Cross-sectional magnetic resonance imaging study of lumbar disc degeneration in 200healthy individuals" 11 : 501-507, 2009

49 Benneker LM, "Correlation of radiographic and MRI parameters to morphological and biochemical assessment of intervertebral disc degeneration" 14 : 27-35, 2005

50 Bechara BP, "Correlation of pain with objective quantification of magnetic resonance images in older adults with chronic low back pain" 39 : 469-475, 2014

51 Shambrook J, "Clinical presentation of low back pain and association with risk factors according to findings on magnetic resonance imaging" 152 : 1659-1665, 2011

52 Bendix T, "Burned-out discs stop hurting: fact or fiction?" 33 : E962-E967, 1976

53 Millecamps M, "Behavioral signs of axial low back pain and motor impairment correlate with the severity of intervertebral disc degeneration in a mouse model" 15 : 2524-2537, 2015

54 Fisher ES, "Avoiding the unintended consequences of growth in medical care: how might more be worse?" 281 : 446-453, 1999

55 Beattie PF, "Associations between patient report of symptoms and anatomic impairment visible on lumbar magnetic resonance imaging" 25 : 819-828, 2000

56 Cheung KM, "Are"patterns"of lumbar disc degeneration associated with low back pain? : new insights based on skipped level disc pathology" 37 : E430-E438, 2012

57 Stadnik TW, "Annular tears and disk herniation : prevalence and contrast enhancement on MR images in the absence of low back pain or sciatica" 206 : 49-55, 1998

58 Jordan KP, "Annual consultation prevalence of regional musculoskeletal problems in primary care : an observational study" 11 : 144-, 2010

59 Palmgren T, "An immunohistochemical study of nerve structures in the anulus fibrosus of human normal lumbar intervertebral discs" 24 : 2075-2079, 1999

60 Paajanen H, "Age-dependent correlation of low-back pain and lumbar disc regeneration" 116 : 106-107, 1997

61 O’Neill C, "Accuracy of MRI for diagnosis of discogenic pain" 11 : 311-326, 2008

62 Boden SD, "Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects : a prospective investigation" 72 : 403-408, 1990

63 Dagenais S, "A systematic review of low back pain cost of illness studies in the United States and internationally" 8 : 8-20, 2008

64 Ract I, "A review of the value of MRI signs in low back pain" 96 : 239-249, 2015

65 Crock HV, "A reappraisal of intervertebral disc lesions" 1 : 983-989, 1970

66 Boos N, "1995 Volvo Award in clinical sciences : the diagnostic accuracy of magnetic resonance imaging, work perception, and psychosocial factors in identifying symptomatic disc herniations" 20 : 2613-2625, 1995