Does Lumbar Disc Degeneration on Magnetic Resonance Imaging Associate With Low Back Symptom Severity in Young Finnish Adults?

Abstract

A cross-sectional magnetic resonance imaging study with questionnaires on low back pain (LBP) and functional limitations. To investigate the association between lumbar intervertebral disc degeneration (DD) and low back symptom severity among young Finnish adults. Both LBP and lumbar DD are common already in adolescence, but very little is known of their association in young adults. Young adults belonging to a birth cohort (n=874) were invited to lumbar magnetic resonance imaging using a 1.5-T scanner. Data on LBP and functional limitations at the ages of 18, 19, and 21 years were used to cluster the subjects with respect to low back symptoms using latent class analysis. The prevalence and 95% confidence intervals of DD at 21 years and the sum score of DD at all lumbar levels were compared between the clusters. The contribution of DD and other imaging findings (herniations, anular tears, Modic changes, spondylolytic defects) to symptom severity was analyzed with logistic regression analysis. Latent class analysis produced five clusters from the 554 subjects, ranging from a cluster where subjects (n=65) had been painful at all time points to an asymptomatic cluster (n=168). DD was more prevalent in the three most symptomatic clusters compared to the two least symptomatic ones. Similar findings were obtained for the DD sum scores. Lumbar DD was related to symptom severity independently of other degenerative findings. Moreover, moderately degenerated discs were more likely than mildly degenerated discs to be associated with the most severe low back symptoms. Intervertebral DD was associated with low back symptom severity among young adults, suggesting that the symptoms may have a discogenic origin at this age. However, DD was also found in one-third of asymptomatic subjects.