Abstract
Background context
Existing research on lumbar disc degeneration has remained inconclusive regarding
its etiology, pathogenesis, symptomatology, prevention, and management. Degenerative
disc disease (DDD) and disc prolapse (DP) are common diseases affecting the lumbar
discs. Although they manifest clinically differently, existing studies on disc degeneration
have included patients with both these features, leading to wide variations in observations.
The possible relationship or disaffect between DDD and DP is not fully evaluated.
Purpose
To analyze the patterns of lumbar disc degeneration in patients with chronic back
pain and DDD and those with acute DP.
Study design
Prospective, magnetic resonance imaging–based radiological study.
Methods
Two groups of patients (aged 20–50 years) were prospectively studied. Group 1 included
patients requiring a single level microdiscectomy for acute DP. Group 2 included patients
with chronic low back pain and DDD. Discs were assessed by magnetic resonance imaging
through Pfirmann grading, Schmorl nodes, Modic changes, and the total end-plate damage
score for all the five lumbar discs.
Results
Group 1 (DP) had 91 patients and group 2 (DDD) had 133 patients. DP and DDD patients
differed significantly in the number, extent, and severity of degeneration. DDD patients
had a significantly higher number of degenerated discs than DP patients (p<.000).
The incidence of multilevel and pan-lumbar degeneration was also significantly higher
in DDD group. The pattern of degeneration also differed in both the groups. DDD patients
had predominant upper lumbar involvement, whereas DP patients had mainly lower lumbar
degeneration. Modic changes were more common in DP patients, especially at the prolapsed
level. Modic changes were present in 37% of prolapsed levels compared with 9.9% of
normal discs (p<.00). The total end-plate damage score had a positive correlation
with disc degeneration in both the groups. Further the mean total end-plate damage
score at prolapsed level was also significantly higher.
Conclusion
The results suggest that patients with disc prolapse, and those with back pain with
DDD are clinically and radiologically different groups of patients with varying patterns,
severity, and extent of disc degeneration. This is the first study in literature to
compare and identify significant differences in these two commonly encountered patient
groups. In patients with single-level DP, the majority of the other discs are nondegenerate,
the lower lumbar spine is predominantly involved and the end-plate damage is higher.
Patients with back pain and DDD have larger number of degenerate discs, early multilevel
degeneration, and predominant upper lumbar degeneration. The knowledge that these
two groups of patients are different clinically and radiologically is critical for
our improved understanding of the disease and for future studies on disc degeneration
and disc prolapse.
Keywords
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Article info
Publication history
Published online: November 13, 2013
Accepted:
October 21,
2013
Received:
February 1,
2013
Footnotes
FDA device/drug status: Not applicable.
Author disclosures: RMK: Grant: Ganga Orthopedic Research and Education Foundation (B, Paid directly to institution). APS: Grant: Ganga Orthopedic Research and Education Foundation (B, Paid directly to institution). SR: Grant: Ganga Orthopedic Research and Education Foundation (B, Paid directly to institution).
The disclosure key can be found on the Table of Contents and at www.TheSpineJournalOnline.com.
Funded by Ganga Orthopedic Research and Education Foundation. This study was approved by Internal Review Board of Ganga Hospital, Coimbatore, India.
Identification
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© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
