Abstract
BackgroundRadiographic features of lumbar disc degeneration (LDD) are common findings in patients with chronic mechanical low back pain; however, its role in disability and intensity of pain is debatable. This study aims to investigate the associations of the x-ray features of LDD and lumbar spondylolisthesis with severity of disability and intensity of pain.MethodsA cross-sectional study was conducted on 439 patients with chronic mechanical low back pain who attended the rheumatology clinic, National Hospital of Sri Lanka, Colombo, from May 2012 to May 2014. Severity of disability was measured using Modified Oswestry Disability Index and intensity of pain was assessed using numeric rating scale (0–100). X-ray features of LDD (disc space narrowing, anterior osteophytes and overall LDD) and spondylolisthesis were assessed in lateral recumbent lumbar x-rays (L1/L2 to L5/S1) and graded by a consultant radiologist blinded to clinical data. Generalised linear model with linear response was used to assess the associations of x-ray features of LDD with severity of disability and intensity of pain adjusting for age, gender, body mass index and pain radiating into legs.ResultsMean age was 48.99 ± 11.21 and 323 (73.58%) were females. 87 (19.82%) were obese. Mean severity of disability was 30.95 ± 13.67 and mean intensity of pain was 45.50 ± 20.37. 69 (15.72%), 26 (5.92%) and 85 (19.36%) patients had grade 2 disc space narrowing, anterior osteophytes and overall LDD, respectively. 51 (11.62%) patients had lumbar spondylolisthesis. Grade of disc space narrowing and overall LDD were not associated with severity of disability or intensity of pain. The presence of lumbar spondylolisthesis was associated with severity of disability. Female gender and pain radiating into legs were associated with severity of disability and intensity of pain. Advancing age was associated with x-ray features of LDD and lumbar spondylolisthesis.ConclusionsLumbar spondylolisthesis is associated with severity of disability in patients with chronic mechanical low back pain. Associations of x-ray features of LDD with severity of disability and intensity of pain are inconclusive. Female gender and pain radiating into legs are significant confounders.
Highlights
Radiographic features of lumbar disc degeneration (LDD) are common findings in patients with chronic mechanical low back pain; its role in disability and intensity of pain is debatable
The objective of our study was to assess the associations of the x-ray features of lumbar disc degeneration and lumbar spondylolisthesis with severity of disability and intensity of pain in patients with chronic mechanical low back pain adjusting for age, gender, body mass index (BMI) and pain radiating into legs
In this study we assessed the associations of x-ray features of LDD and lumbar spondylolisthesis with severity of disability and intensity of pain in patients with chronic mechanical low back pain adjusting for age, gender, BMI and pain radiating into legs
Summary
Radiographic features of lumbar disc degeneration (LDD) are common findings in patients with chronic mechanical low back pain; its role in disability and intensity of pain is debatable. Disability due to chronic low back pain is one of the leading health care problems in most regions of the world including South Asia [1]. It affects all aspects of life including physical, mental, and social well-being [2]. Most chronic low back pains are related to mechanical causes including injuries of the musculoskeletal structures of the spine and pathologies associated with lumbar disc degeneration (LDD) [5, 6]. MRI is not a cost effective method in routine spinal imaging in developing countries and clinicians in developing countries like Sri Lanka regularly use x-ray lumbar spine as a feasible option for assessing features related to LDD [7]
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