Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2016

Open Access 01-12-2016 | Research article

Lumbar disc degeneration is associated with modic change and high paraspinal fat content – a 3.0T magnetic resonance imaging study

Authors: Andrew J. Teichtahl, Donna M. Urquhart, Yuanyuan Wang, Anita E. Wluka, Richard O’Sullivan, Graeme Jones, Flavia M. Cicuttini

Published in: BMC Musculoskeletal Disorders | Issue 1/2016

Login to get access

Abstract

Background

Degenerative disc disease of the lumbar spine is common, with severe disease increasing the risk for chronic low back pain. This cross-sectional study examined whether disc degeneration is representative of a ‘whole-organ’ pathology, by examining its association with bone (vertebral endplate) and soft tissue (paraspinal muscle fat) abnormalities.

Methods

Seventy-two community-based individuals unselected for low back pain, had Magnetic Resonance Imaging (MRI). Lumbosacral disc degeneration was determined via the Pfirrmann grading system, a validated method to assess the intervertebral disc, distinguishing the nucleus and annulus, the signal intensity and the height of the intervertebral disc. Modic change and high paraspinal muscle fat content was also measured from MRI.

Results

Severe disc degeneration was associated, or tended to be associated with type 2 Modic change from L2 to L5 (OR range 3.5 to 25.3, p ≤ 0.06). Moreover, severe disc degeneration at all intervertebral levels was associated with or tended to be associated with high fat content of the paraspinal muscles (OR range 3.7 to 14.3, p ≤ 0.09).

Conclusion

These data demonstrate that disc degeneration of the lumbar spine is commonly accompanied by Modic change and high fat content of paraspinal muscles, thus representing a ‘whole-organ’ pathology. Longitudinal studies are required to determine the temporal relationship between these structural abnormalities. Understanding this may have the potential to identify novel targets for the treatment and prevention of lumbosacral disc degeneration.
Literature
1.
Powell MC, Wilson M, Szypryt P, Symonds EM, Worthington BS. Prevalence of lumbar disc degeneration observed by magnetic resonance in symptomless women. Lancet. 1986;2(8520):1366–7.CrossRefPubMed
2.
3.
Luoma K, Riihimaki H, Luukkonen R, Raininko R, Viikari-Juntura E, Lamminen A. Low back pain in relation to lumbar disc degeneration. Spine. 2000;25(4):487–92.CrossRefPubMed
4.
Boos N, Weissbach S, Rohrbach H, Weiler C, Spratt KF, Nerlich AG. Classification of age-related changes in lumbar intervertebral discs: 2002 Volvo Award in basic science. Spine (Phila Pa 1976). 2002;27(23):2631–44.CrossRef
5.
Thompson JP, Pearce RH, Schechter MT, Adams ME, Tsang IK, Bishop PB. Preliminary evaluation of a scheme for grading the gross morphology of the human intervertebral disc. Spine (Phila Pa 1976). 1990;15(5):411–5.CrossRef
6.
Mimura M, Panjabi MM, Oxland TR, Crisco JJ, Yamamoto I, Vasavada A. Disc degeneration affects the multidirectional flexibility of the lumbar spine. Spine (Phila Pa 1976). 1994;19(12):1371–80.CrossRef
7.
Lane NE, Nevitt MC, Genant HK, Hochberg MC. Reliability of new indices of radiographic osteoarthritis of the hand and hip and lumbar disc degeneration. J Rheumatol. 1993;20(11):1911–8.PubMed
8.
Yu S, Haughton VM, Sether LA, Ho KC, Wagner M. Criteria for classifying normal and degenerated lumbar intervertebral disks. Radiology. 1989;170(2):523–6.CrossRefPubMed
9.
Kader DF, Wardlaw D, Smith FW. Correlation between the MRI changes in the lumbar multifidus muscles and leg pain. Clin Radiol. 2000;55(2):145–9.CrossRefPubMed
10.
Urquhart DM, Kurniadi I, Triangto K, Wang Y, Wluka AE, O’Sullivan R, Jones G, Cicuttini FM. Obesity is Associated With Reduced Disc Height in the Lumbar Spine but not at the Lumbosacral Junction. Spine. 2014;12:12.
11.
Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976). 2001;26(17):1873–8.CrossRef
12.
Kettler A, Wilke HJ. Review of existing grading systems for cervical or lumbar disc and facet joint degeneration. Eur Spine J. 2006;15(6):705–18. Epub 2005 Sep 20.CrossRefPubMed
13.
Teichtahl AJ, Wluka AE, Davies-Tuck ML, Cicuttini FM. Imaging of knee osteoarthritis. Best Pract Res Clin Rheumatol. 2008;22(6):1061–74.CrossRefPubMed
14.
Toyone T, Takahashi K, Kitahara H, Yamagata M, Murakami M, Moriya H. Vertebral bone-marrow changes in degenerative lumbar disc disease. An MRI study of 74 patients with low back pain. J Bone Joint Surg (Br). 1994;76(5):757–64.
15.
Mitra D, Cassar-Pullicino VN, McCall IW. Longitudinal study of vertebral type-1 end-plate changes on MR of the lumbar spine. Eur Radiol. 2004;14(9):1574–81. Epub 2004 Apr 2.CrossRefPubMed
16.
Kuisma M, Karppinen J, Niinimaki J, Ojala R, Haapea M, Heliovaara M, Korpelainen R, Taimela S, Natri A, Tervonen O. Modic changes in endplates of lumbar vertebral bodies: prevalence and association with low back and sciatic pain among middle-aged male workers. Spine (Phila Pa 1976). 2007;32(10):1116–22.CrossRef
17.
18.
19.
Weishaupt D, Zanetti M, Hodler J, Boos N. MR imaging of the lumbar spine: prevalence of intervertebral disk extrusion and sequestration, nerve root compression, end plate abnormalities, and osteoarthritis of the facet joints in asymptomatic volunteers. Radiology. 1998;209(3):661–6.CrossRefPubMed
20.
Kjaer P, Korsholm L, Bendix T, Sorensen JS, Leboeuf-Yde C. Modic changes and their associations with clinical findings. Eur Spine J. 2006;15(9):1312–9. Epub 2006 Aug 9.CrossRefPubMedPubMedCentral
21.
Modic MT, Masaryk TJ, Ross JS, Carter JR. Imaging of degenerative disk disease. Radiology. 1988;168(1):177–86.CrossRefPubMed
22.
Kjaer P, Bendix T, Sorensen JS, Korsholm L, Leboeuf-Yde C. Are MRI-defined fat infiltrations in the multifidus muscles associated with low back pain? BMC Med. 2007;5:2.CrossRefPubMedPubMedCentral
23.
Fischer MA, Nanz D, Shimakawa A, Schirmer T, Guggenberger R, Chhabra A, Carrino JA, Andreisek G. Quantification of muscle fat in patients with low back pain: comparison of multi-echo MR imaging with single-voxel MR spectroscopy. Radiology. 2013;266(2):555–63. doi:10.​1148/​radiol.​12120399. Epub 2012 Nov 9.CrossRefPubMed
24.
Mengiardi B, Schmid MR, Boos N, Pfirrmann CW, Brunner F, Elfering A, Hodler J. Fat content of lumbar paraspinal muscles in patients with chronic low back pain and in asymptomatic volunteers: quantification with MR spectroscopy. Radiology. 2006;240(3):786–92.CrossRefPubMed
25.
Teichtahl AJ, Urquhart DM, Wang Y, Wluka AE, O’Sullivan R, Jones G, Cicuttini FM. Physical inactivity is associated with narrower lumbar intervertebral discs, high fat content of paraspinal muscles and low back pain and disability. Arthritis Res Ther. 2015;17(1):114.CrossRefPubMedPubMedCentral
26.
Teichtahl AJ, Urquhart DM, Wang Y, Wluka AE, Wijethilake P, O’Sullivan R, Cicuttini FM. Fat infiltration of paraspinal muscles is associated with low back pain, disability, and structural abnormalities in community-based adults. Spine J. 2015;28(15):00326–5.
27.
Modic MT, Steinberg PM, Ross JS, Masaryk TJ, Carter JR. Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology. 1988;166(1 Pt 1):193–9.CrossRefPubMed
28.
Von Korff M, Ormel J, Keefe FJ, Dworkin SF. Grading the severity of chronic pain. Pain. 1992;50(2):133–49.CrossRef
29.
Smith BH, Penny KI, Purves AM, Munro C, Wilson B, Grimshaw J, Chambers WA, Smith WC. The Chronic Pain Grade questionnaire: validation and reliability in postal research. Pain. 1997;71(2):141–7.CrossRefPubMed
30.
West W, West KP, Younger EN, Cornwall D. Degenerative disc disease of the lumbar spine on MRI. West Indian Med J. 2010;59(2):192–5.PubMed
31.
Kuisma M, Karppinen J, Haapea M, Niinimaki J, Ojala R, Heliovaara M, Korpelainen R, Kaikkonen K, Taimela S, Natri A, Tervonen O. Are the determinants of vertebral endplate changes and severe disc degeneration in the lumbar spine the same? A magnetic resonance imaging study in middle-aged male workers. BMC Musculoskelet Disord. 2008;9:51. doi:10.​1186/​471-2474-9-51.CrossRefPubMedPubMedCentral
32.
Yu LP, Qian WW, Yin GY, Ren YX, Hu ZY. MRI assessment of lumbar intervertebral disc degeneration with lumbar degenerative disease using the Pfirrmann grading systems. PLoS One. 2012;7(12):e48074.CrossRefPubMedPubMedCentral
33.
Rajasekaran S, Babu JN, Arun R, Armstrong BR, Shetty AP, Murugan S. ISSLS prize winner: A study of diffusion in human lumbar discs: a serial magnetic resonance imaging study documenting the influence of the endplate on diffusion in normal and degenerate discs. Spine (Phila Pa 1976). 2004;29(23):2654–67.CrossRef
34.
Rossi A, Zoico E, Goodpaster BH, Sepe A, Di Francesco V, Fantin F, Pizzini F, Corzato F, Vitali A, Micciolo R, Harris TB, Cinti S, Zamboni M. Quantification of intermuscular adipose tissue in the erector spinae muscle by MRI: agreement with histological evaluation. Obesity (Silver Spring). 2010;18(12):2379–84.CrossRefPubMedPubMedCentral
35.
Mitsiopoulos N, Baumgartner RN, Heymsfield SB, Lyons W, Gallagher D, Ross R. Cadaver validation of skeletal muscle measurement by magnetic resonance imaging and computerized tomography. J Appl Physiol (1985). 1998;85(1):115–22.
36.
Phoenix J, Betal D, Roberts N, Helliwell TR, Edwards RH. Objective quantification of muscle and fat in human dystrophic muscle by magnetic resonance image analysis. Muscle Nerve. 1996;19(3):302–10.CrossRefPubMed
37.
Griffith JF, Wang YX, Antonio GE, Choi KC, Yu A, Ahuja AT, Leung PC. Modified Pfirrmann grading system for lumbar intervertebral disc degeneration. Spine (Phila Pa 1976). 2007;32(24):E708–12.CrossRef
38.
Parkkola R, Rytokoski U, Kormano M. Magnetic resonance imaging of the discs and trunk muscles in patients with chronic low back pain and healthy control subjects. Spine (Phila Pa 1976). 1993;18(7):830–6.CrossRef
39.
Philips HC. Avoidance behaviour and its role in sustaining chronic pain. Behav Res Ther. 1987;25(4):273–9.CrossRefPubMed
40.
Gatchel RJ, Polatin PB, Mayer TG. The dominant role of psychosocial risk factors in the development of chronic low back pain disability. Spine (Phila Pa 1976). 1995;20(24):2702–9.CrossRef
41.
Vlaeyen JW, Kole-Snijders AM, Boeren RG, van Eek H. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain. 1995;62(3):363–72.CrossRefPubMed
Metadata
Title
Lumbar disc degeneration is associated with modic change and high paraspinal fat content – a 3.0T magnetic resonance imaging study
Authors
Andrew J. Teichtahl
Donna M. Urquhart
Yuanyuan Wang
Anita E. Wluka
Richard O’Sullivan
Graeme Jones
Flavia M. Cicuttini
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2016
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-016-1297-z

Other articles of this Issue 1/2016

BMC Musculoskeletal Disorders 1/2016 Go to the issue

Research article

Decreased severity of experimental autoimmune arthritis in peptidylarginine deiminase type 4 knockout mice

Research article

Opting to wear prismatic spectacles was associated with reduced neck pain in dental personnel: a longitudinal cohort study

Research article

Associations of LBX1 gene and adolescent idiopathic scoliosis susceptibility: a meta-analysis based on 34,626 subjects

Research article

Prevalence of biologics monotherapy in a cohort of patients with Rheumatoid Arthritis in daily clinical practice

Research article

Alterations in neuromuscular function in girls with generalized joint hypermobility

Research article

Obesity is associated with more disability at presentation and after treatment in low back pain but not in neck pain: findings from the OIOC registry