Beyond the AJR: Lack of Association Between Radiographic Changes and Back Pain-Related Disability in the Chingford 1000 Study.

Abstract

This study [1] characterizes the longitudinal and cross-sectional associations between lumbar radiographic findings and back pain-related disability (BPRD) in the Chingford 1000 Women Study, a population-based longitudinal cohort. One rheumatologist classified the degree of disc space narrowing (DSN), endplate sclerosis or deformity, and osteophytes by combining the number of vertebral bodies involved and type of osteoarthritic changes using the Kellgren-Lawrence grading (KLG) system and a previously described semiquantitative method. The researchers generated separate composite scores for KLG, DSN, and osteophyte grade. The data were derived from different study stages including year 6 physical activity score; year 9 imaging, other covariates, and cross-sectional outcomes; and year 15 longitudinal outcomes. The primary outcome was self-reported back pain of at least one day in the last 12 months from the St. Thomas disability questionnaire. Covariates included age, body mass index, smoking, back pain, bisphosphonate usage, and self-reported physical activity. A total of 650 women and 443 women met inclusion criteria for the cross-sectional and longitudinal analyses, respectively. Median BPRD was zero; approximately two thirds of participants reported no BPRD. No lumbar spine radiographic findings were found in 154/650 women. Of the women with one or more KLG composite changes, osteophyte composite changes, or DSN composite changes, no association was found with BPRD in either analysis. In summary, in this cohort, no association was found between the number of segments with radiographic changes (KLG composite, osteophyte composite, DSN composite) and more severe BPRD.