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European Spine Journal

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16-02-2024 | Disc Herniation | Original Article

Obesity increases the odds of intervertebral disc herniation and spinal stenosis; an MRI study of 1634 low back pain patients

Authors: Anand H. Segar, Alice Baroncini, Jocelyn P. G. Urban, Jeremy Fairbank, Andrew Judge, Iain McCall

Published in: European Spine Journal | Issue 3/2024

Abstract

Purpose

The objective of this study was to examine the relationships between BMI and intervertebral disc degeneration (DD), disc herniation (DH) and spinal stenosis (SS) using a large, prospectively recruited and heterogeneous patient population.

Methods

Patients were recruited through the European Genodisc Study. An experienced radiologist scored MRI images for DD, DH and SS. Multivariate linear and logistic regression analyses were used to model the relationship between these variables and BMI with adjustment for patient and MRI confounders.

Results

We analysed 1684 patients with a mean age of 51 years and BMI of 27.2 kg/m². The mean DD score was 2.6 (out of 5) with greater DD severity with increasing age (R2 = 0.44). In the fully adjusted model, a 10-year increase in age and a 5 kg/m² increase in BMI were associated, respectively, with a 0.31-unit [95% CI 0.29,0.34] and 0.04-unit [CI 0.01,0.07] increase in degeneration. Age (OR 1.23 [CI 1.06,1.43]) and BMI (OR 2.60 [CI 2.28,2.96]) were positively associated with SS. For DH, age was a negative predictor (OR 0.70 [CI 0.64,0.76]) but for BMI (OR 1.19 [CI 1.07,1.33]), the association was positive. BMI was the strongest predictor of all three features in the upper lumbar spine.

Conclusions

While an increase in BMI was associated with only a slight increase in DD, it was a stronger predictor for DH and SS, particularly in the upper lumbar discs, suggesting weight loss could be a useful strategy for helping prevent disorders associated with these pathologies.

Vos T, Flaxman AD, Naghavi M et al (2012) Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380:2163–2196. https://doi.org/10.1016/S0140-6736(12)61729-2CrossRefPubMedPubMedCentral

GBD (2021) Low Back Pain Collaborators (2023) Global, regional, and national burden of low back pain, 1990–2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol 5:e316–e329. https://doi.org/10.1016/S2665-9913(23)00098-XCrossRef

Brinjikji W, Luetmer PH, Comstock B et al (2015) Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol 36:811–816. https://doi.org/10.3174/ajnr.A4173CrossRefPubMedPubMedCentral

Pfirrmann CW, Metzdorf A, Zanetti M et al (2001) Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976) 26:1873–1878. https://doi.org/10.1097/00007632-200109010-00011CrossRefPubMed

Mok FPS, Samartzis D, Karppinen J et al (2016) Modic changes of the lumbar spine: prevalence, risk factors, and association with disc degeneration and low back pain in a large-scale population-based cohort. Spine J 16:32–41. https://doi.org/10.1016/j.spinee.2015.09.060CrossRefPubMed

Luoma K, Vehmas T, Kerttula L et al (2016) Chronic low back pain in relation to Modic changes, bony endplate lesions, and disc degeneration in a prospective MRI study. Eur Spine J 25:2873–2881. https://doi.org/10.1007/s00586-016-4715-xCrossRefPubMed

Battié MC, Videman T, Levälahti E et al (2008) Genetic and environmental effects on disc degeneration by phenotype and spinal level: a multivariate twin study. Spine (Phila Pa 1976) 33:2801–2808. https://doi.org/10.1097/BRS.0b013e31818043b7CrossRefPubMed

Samartzis D, Karppinen J, Chan D et al (2012) The association of lumbar intervertebral disc degeneration on magnetic resonance imaging with body mass index in overweight and obese adults: a population-based study. Arthritis Rheum 64:1488–1496. https://doi.org/10.1002/art.33462CrossRefPubMed

Dario AB, Ferreira ML, Refshauge KM et al (2015) The relationship between obesity, low back pain, and lumbar disc degeneration when genetics and the environment are considered: a systematic review of twin studies. Spine J 15:1106–1117. https://doi.org/10.1016/j.spinee.2015.02.001CrossRefPubMed

10.

Maurer E, Klinger C, Lorbeer R et al (2022) Association between cardiovascular risk factors and degenerative disc disease of the thoracolumbar spine in the general population: results from the KORA MRI study. Acta Radiol 63:750–759. https://doi.org/10.1177/02841851211010391CrossRefPubMed

11.

Sheng B, Feng C, Zhang D et al (2017) Associations between obesity and spinal diseases: a medical expenditure panel study analysis. Int J Environ Res Public Health 14:183. https://doi.org/10.3390/ijerph14020183CrossRefPubMedPubMedCentral

12.

Kanayama M, Togawa D, Takahashi C et al (2009) Cross-sectional magnetic resonance imaging study of lumbar disc degeneration in 200 healthy individuals. J Neurosurg Spine 11:501–507. https://doi.org/10.3171/2009.5.SPINE08675CrossRefPubMed

13.

Lener S, Wipplinger C, Hartmann S et al (2020) The impact of obesity and smoking on young individuals suffering from lumbar disc herniation: a retrospective analysis of 97 cases. Neurosurg Rev 43:1297–1303. https://doi.org/10.1007/s10143-019-01151-yCrossRefPubMed

14.

Mateos-Valenzuela AG, González-Macías ME, Ahumada-Valdez S et al (2020) Risk factors and association of body composition components for lumbar disc herniation in Northwest Mexico. Sci Rep 10:18479. https://doi.org/10.1038/s41598-020-75540-5CrossRefPubMedPubMedCentral

15.

Passias PG, Fernandez L, Horn SR et al (2022) Bariatric surgery lowers rates of spinal symptoms and spinal surgery in a morbidly obese population. Clin Spine Surg 35:371–375. https://doi.org/10.1097/BSD.0000000000001346CrossRefPubMed

16.

Venkatesan M, Uzoigwe CE, Perianayagam G et al (2012) Is cauda equina syndrome linked with obesity? J Bone Joint Surg Br 94:1551–1556. https://doi.org/10.1302/0301-620X.94B11.29652CrossRefPubMed

17.

Shiri R, Lallukka T, Karppinen J, Viikari-Juntura E (2014) Obesity as a risk factor for sciatica: a meta-analysis. Am J Epidemiol 179:929–937. https://doi.org/10.1093/aje/kwu007CrossRefPubMed

18.

Stienen MN, Joswig H, Smoll NR et al (2016) Influence of body mass index on subjective and objective measures of pain, functional impairment, and health-related quality of life in lumbar degenerative disc disease. World Neurosurg 96:570-577.e1. https://doi.org/10.1016/j.wneu.2016.09.070CrossRefPubMed

19.

Tsarouhas A, Soufla G, Tsarouhas K et al (2017) Molecular profile of major growth factors in lumbar intervertebral disc herniation: correlation with patient clinical and epidemiological characteristics. Mol Med Rep 15:2195–2203. https://doi.org/10.3892/mmr.2017.6221CrossRefPubMedPubMedCentral

20.

Rodriguez-Martinez NG, Perez-Orribo L, Kalb S et al (2016) The role of obesity in the biomechanics and radiological changes of the spine: an in vitro study. J Neurosurg Spine 24:615–623. https://doi.org/10.3171/2015.7.SPINE141306CrossRefPubMed

21.

Battié MC, Lazáry A, Fairbank J et al (2014) Disc degeneration-related clinical phenotypes. Eur Spine J 23(Suppl 3):S305–S314. https://doi.org/10.1007/s00586-013-2903-5CrossRefPubMed

22.

Jamaludin A, Lootus M, Kadir T et al (2017) ISSLS PRIZE IN BIOENGINEERING SCIENCE 2017: automation of reading of radiological features from magnetic resonance images (MRIs) of the lumbar spine without human intervention is comparable with an expert radiologist. Eur Spine J 26:1374–1383. https://doi.org/10.1007/s00586-017-4956-3CrossRefPubMed

23.

Cheung KMC, Karppinen J, Chan D et al (2009) Prevalence and pattern of lumbar magnetic resonance imaging changes in a population study of one thousand forty-three individuals. Spine (Phila Pa 1976) 34:934–940. https://doi.org/10.1097/BRS.0b013e3181a01b3fCrossRefPubMed

24.

Kreiner DS, Shaffer WO, Baisden JL et al (2013) An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis (update). Spine J 13:734–743. https://doi.org/10.1016/j.spinee.2012.11.059CrossRefPubMed

25.

Battié MC, Videman T, Gill K et al (1991) 1991 Volvo Award in clinical sciences. Smoking and lumbar intervertebral disc degeneration: an MRI study of identical twins. Spine (Phila Pa 1976) 16:1015–1021CrossRefPubMed

26.

Battié MC, Videman T, Gibbons LE et al (1995) 1995 Volvo Award in clinical sciences. Determinants of lumbar disc degeneration. A study relating lifetime exposures and magnetic resonance imaging findings in identical twins. Spine (Phila Pa 1976) 20:2601–2612CrossRefPubMed

27.

Fields AJ, Ballatori A, Liebenberg EC, Lotz JC (2018) Contribution of the endplates to disc degeneration. Curr Mol Bio Rep 4:151–160. https://doi.org/10.1007/s40610-018-0105-yCrossRef

28.

Lawan A, Crites Videman J, Battié MC (2021) The association between vertebral endplate structural defects and back pain: a systematic review and meta-analysis. Eur Spine J 30:2531–2548. https://doi.org/10.1007/s00586-021-06865-6CrossRefPubMed

29.

Teraguchi M, Yoshimura N, Hashizume H et al (2014) Prevalence and distribution of intervertebral disc degeneration over the entire spine in a population-based cohort: the Wakayama Spine Study. Osteoarthritis Cartilage 22:104–110. https://doi.org/10.1016/j.joca.2013.10.019CrossRefPubMed

30.

Hangai M, Kaneoka K, Kuno S et al (2008) Factors associated with lumbar intervertebral disc degeneration in the elderly. Spine J 8:732–740. https://doi.org/10.1016/j.spinee.2007.07.392CrossRefPubMed

31.

Liuke M, Solovieva S, Lamminen A et al (2005) Disc degeneration of the lumbar spine in relation to overweight. Int J Obes (Lond) 29:903–908. https://doi.org/10.1038/sj.ijo.0802974CrossRefPubMed

32.

Kasch R, Truthmann J, Hancock MJ et al (2022) Association of lumbar MRI findings with current and future back pain in a population-based cohort study. Spine (Phila Pa 1976) 47:201–211. https://doi.org/10.1097/BRS.0000000000004198CrossRefPubMed

33.

Takatalo J, Karppinen J, Taimela S et al (2013) Association of abdominal obesity with lumbar disc degeneration–a magnetic resonance imaging study. PLoS ONE 8:e56244. https://doi.org/10.1371/journal.pone.0056244ADSCrossRefPubMedPubMedCentral

34.

Segar AH, Fairbank JCT, Urban J (2019) Leptin and the intervertebral disc: a biochemical link exists between obesity, intervertebral disc degeneration and low back pain-an in vitro study in a bovine model. Eur Spine J 28:214–223. https://doi.org/10.1007/s00586-018-5778-7CrossRefPubMed

35.

Francisco V, Pino J, González-Gay MÁ et al (2022) A new immunometabolic perspective of intervertebral disc degeneration. Nat Rev Rheumatol 18:47–60. https://doi.org/10.1038/s41584-021-00713-zCrossRefPubMed

36.

Curic G (2020) Intervertebral Disc and Adipokine Leptin-Loves Me, Loves Me Not. Int J Mol Sci 22:375. https://doi.org/10.3390/ijms22010375CrossRefPubMedPubMedCentral

37.

Lidar Z, Behrbalk E, Regev GJ et al (2012) Intervertebral disc height changes after weight reduction in morbidly obese patients and its effect on quality of life and radicular and low back pain. Spine (Phila Pa 1976) 37:1947–1952. https://doi.org/10.1097/BRS.0b013e31825fab16CrossRefPubMed

38.

Jhawar BS, Fuchs CS, Colditz GA, Stampfer MJ (2006) Cardiovascular risk factors for physician-diagnosed lumbar disc herniation. Spine J 6:684–691. https://doi.org/10.1016/j.spinee.2006.04.016CrossRefPubMed

39.

Segar AH, Urban JPG, Fairbank JCT et al (2016) The Association Between Body Mass Index (BMI) and back or leg pain in patients with spinal conditions: results from the Genodisc study. Spine (Phila Pa 1976) 41:E1237–E1243. https://doi.org/10.1097/BRS.0000000000001606CrossRefPubMed

40.

Saberi H, Rahimi L, Jahani L (2009) A comparative MRI study of upper and lower lumbar motion segments in patients with low back pain. J Spinal Disord Tech 22:507–510. https://doi.org/10.1097/BSD.0b013e3181927051CrossRefPubMed

41.

Cummins J, Lurie JD, Tosteson TD et al (2006) Descriptive epidemiology and prior healthcare utilization of patients in the Spine Patient Outcomes Research Trial’s (SPORT) three observational cohorts: disc herniation, spinal stenosis, and degenerative spondylolisthesis. Spine (Phila Pa 1976) 31:806–814. https://doi.org/10.1097/01.brs.0000207473.09030.0dCrossRefPubMed

42.

Urban JPG, Roberts S (2003) Degeneration of the intervertebral disc. Arthritis Res Ther 5:120–130. https://doi.org/10.1186/ar629CrossRefPubMedPubMedCentral

43.

Ishimoto Y, Yoshimura N, Muraki S et al (2012) Prevalence of symptomatic lumbar spinal stenosis and its association with physical performance in a population-based cohort in Japan: the Wakayama Spine Study. Osteoarthritis Cartilage 20:1103–1108. https://doi.org/10.1016/j.joca.2012.06.018CrossRefPubMed

44.

Kalichman L, Guermazi A, Li L, Hunter DJ (2009) Association between age, sex, BMI and CT-evaluated spinal degeneration features. J Back Musculoskelet Rehabil 22:189–195. https://doi.org/10.3233/BMR-2009-0232CrossRefPubMed

45.

Ishimoto Y, Yoshimura N, Muraki S et al (2013) Associations between radiographic lumbar spinal stenosis and clinical symptoms in the general population: the Wakayama Spine Study. Osteoarthritis Cartilage 21:783–788. https://doi.org/10.1016/j.joca.2013.02.656CrossRefPubMed

46.

Sun C, Wang Z, Tian J-W, Wang Y-H (2018) Leptin-induced inflammation by activating IL-6 expression contributes to the fibrosis and hypertrophy of ligamentum flavum in lumbar spinal canal stenosis. Biosci Rep 38:BSR20171214. https://doi.org/10.1042/BSR20171214

47.

Jensen RK, Jensen TS, Kjaer P, Kent P (2013) Can pathoanatomical pathways of degeneration in lumbar motion segments be identified by clustering MRI findings. BMC Musculoskelet Disord 14:198. https://doi.org/10.1186/1471-2474-14-198CrossRefPubMedPubMedCentral

48.

Miller JA, Schmatz C, Schultz AB (1988) Lumbar disc degeneration: correlation with age, sex, and spine level in 600 autopsy specimens. Spine (Phila Pa 1976) 13:173–178CrossRefPubMed

49.

Kawaguchi Y, Osada R, Kanamori M et al (1999) Association between an aggrecan gene polymorphism and lumbar disc degeneration. Spine (Phila Pa 1976) 24:2456–2460. https://doi.org/10.1097/00007632-199912010-00006CrossRefPubMed

50.

Kawaguchi Y, Kanamori M, Ishihara H et al (2002) The association of lumbar disc disease with vitamin-D receptor gene polymorphism. J Bone Joint Surg Am 84:2022–2028. https://doi.org/10.2106/00004623-200211000-00018CrossRefPubMed

51.

Solovieva S, Lohiniva J, Leino-Arjas P et al (2002) COL9A3 gene polymorphism and obesity in intervertebral disc degeneration of the lumbar spine: evidence of gene-environment interaction. Spine (Phila Pa 1976) 27:2691–2696. https://doi.org/10.1097/00007632-200212010-00008CrossRefPubMed

52.

Hassett G, Hart DJ, Manek NJ et al (2003) Risk factors for progression of lumbar spine disc degeneration: the Chingford Study. Arthritis Rheum 48:3112–3117. https://doi.org/10.1002/art.11321CrossRefPubMed

Title: Obesity increases the odds of intervertebral disc herniation and spinal stenosis; an MRI study of 1634 low back pain patients
Authors: Anand H. Segar
Alice Baroncini
Jocelyn P. G. Urban
Jeremy Fairbank
Andrew Judge
Iain McCall
Publication date: 16-02-2024
Publisher: Springer Berlin Heidelberg
Keywords: Disc Herniation
Spinal Stenosis
Back Pain
Back Pain
Back Pain
Obesity
Obesity
Published in: European Spine Journal / Issue 3/2024
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-024-08154-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Obesity increases the odds of intervertebral disc herniation and spinal stenosis; an MRI study of 1634 low back pain patients

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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