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01-12-2020 | Magnetic Resonance Imaging | Research article

Is intrinsic lumbar spine shape associated with lumbar disc degeneration? An exploratory study

Authors: Janet A. Deane, Anastasia V. Pavlova, Adrian K. P. Lim, Jennifer S. Gregory, Richard M. Aspden, Alison H. McGregor

Published in: BMC Musculoskeletal Disorders | Issue 1/2020

Abstract

Background

Lumbar disc degeneration (LDD) is a condition associated with recurrent low back pain (LBP). Knowledge regarding effective management is limited. As a step towards the identification of risk, prognostic or potentially modifiable factors in LDD patients, the aim of this study was to explore the hypothesis that intrinsic lumbar spine shape is associated with LDD and clinical outcomes in symptomatic adults.

Methods

3 T MRI was used to acquire T2-weighted sagittal images (L1-S1) from 70 healthy controls and LDD patients (mean age 49 years, SD 11, range 31–71 years). Statistical Shape Modelling (SSM) was used to describe lumbar spine shape. SSM identified variations in lumbar shape as ‘modes’ of variation and quantified deviation from the mean. Intrinsic shape differences were determined between LDD groups using analysis of variance with post-hoc comparisons. The relationship between intrinsic shape and self-reported function, mental health and quality of life were also examined.

Results

The first 7 modes of variation explained 91% of variance in lumbar shape. Higher LDD sum scores correlated with a larger lumbar lordosis (Mode 1 (55% variance), P = 0.02), even lumbar curve distribution (Mode 2 (12% variance), P = 0.05), larger anterior-posterior (A-P) vertebral diameter (Mode 3 (10% variance), P = 0.007) and smaller L4-S1 disc spaces (Mode 7 (2% variance), P ≤ 0.001). In the presence of recurrent LBP, LDD was associated with a larger A-P vertebral diameter (Mode 3) and a more even lumbar curvature with smaller L5/S1 disc spaces (Mode 4), which was significantly associated with patient quality of life (P = 0.002–0.04, r_p = 0.43–0.61)).

Conclusions

This exploratory study provides new evidence that intrinsic shape phenotypes are associated with LDD and quality of life in patients. Longitudinal studies are required to establish the potential role of these risk or prognostic shape phenotypes.

Teraguchi M, Yoshimura N, Hashizume H, et al. Prevalence and distribution of intervertebral disc degeneration over the entire spine in a population-based cohort: the Wakayama spine study. Osteoarthr Cartil. 2014;22(104–10):2014.

Livshits G, Popham M, Malkin I, et al. Lumbar disc degeneration and genetic factors are the main risk factors for low back pain in women: the UK twin spine study. Ann Rheum Dis. 2011;70(10):1740–5. https://doi.org/10.1136/ard.2010.137836.CrossRefPubMedPubMedCentral

Pfirrmann CW, Metzdorf A, Zanetti M, et al. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine. 2001;26(17):1873–8 published online first: 2001/09/25.CrossRef

Griffith JF, Wang YX, Antonio GE, et al. Modified Pfirrmann grading system for lumbar intervertebral disc degeneration. Spine. 2007;32(24):E708–12. https://doi.org/10.1097/BRS.0b013e31815a59a0 published online first: 2007/11/17.CrossRefPubMed

Gurung T, Ellard DR, Mistry D, et al. Identifying potential moderators for response to treatment in low back pain: a systematic review. Physiotherapy. 2015;101(3):243–51. https://doi.org/10.1016/j.physio.2015.01.006.CrossRefPubMed

Keller A, Hayden J, Bombardier C, et al. Effect sizes of non-surgical treatments of non specific low-back pain. E Spine J. 2007;16(11):1776–88. https://doi.org/10.1007/s00586-007-0379-x.CrossRef

Meakin JR, Smith FW, Gilbert FJ, et al. The effect of axial load on the sagittal plane curvature of the upright human spine in vivo. J Biomechanics. 2008;41(13):2850–4. https://doi.org/10.1016/j.jbiomech.2008.06.035 published online first: 2008/08/22.CrossRef

Cootes TF, Taylor CJ. [2004] Anatomical statistical models and their role in feature extraction. Br J Radiol;77 Spec No 2:S133-S139. doi: https://doi.org/10.1259/bjr/20343922 [published online first: 2005/01/29].

Ali AH, Cowan AB, Gregory JS, et al. The accuracy of active shape modelling and endplate measurements for characterising the shape of the lumbar spine in the sagittal plane. Comp Methods Biomechanics Biomed Engineering. 2012;15(2):167–72. https://doi.org/10.1080/10255842.2010.518962 published online first: 2012/01/25.CrossRef

10.

Meakin JR, Gregory JS, Smith FW, et al. Characterizing the shape of the lumbar spine using an active shape model: reliability and precision of the method. Spine. 2008;33(7):807–13. https://doi.org/10.1097/BRS.0b013e31816949e6.CrossRefPubMed

11.

Meakin JR, Gregory JS, Aspden RM, et al. The intrinsic shape of the human lumbar spine in the supine, standing and sitting postures: characterization using an active shape model. J Anat. 2009;215(2):206–11. https://doi.org/10.1111/j.1469-7580.2009.01102.x.CrossRefPubMedPubMedCentral

12.

Takatalo J, Karppinen J, Taimela S, et al. Association of Abdominal Obesity with lumbar disc degeneration – a magnetic resonance imaging study. PloS one. 2013;8(2):e56244. https://doi.org/10.1371/journal.pone.0056244.CrossRefPubMedPubMedCentral

13.

Cootes TF, Hill A, Taylor CJ, et al. Use of active shape models for locating structures in medical images. Image Vis Comput. 1994;12(6):355–65. https://doi.org/10.1016/0262-8856(94)90060-4.CrossRef

14.

Pavlova AV, Meakin JR, Cooper K, et al. The lumbar spine has an intrinsic shape specific to each individual that remains a characteristic throughout flexion and extension. Eur Spine J. 2014;23(Suppl 1):S26–32. https://doi.org/10.1007/s00586-013-3162-1 published online first: 2014/01/15.CrossRefPubMed

15.

Pavlova AV, Saunders FR, Muthuri SG, et al. Statistical shape modelling of hip and lumbar spine morphology and their relationship in the MRC National Survey of health and development. J Anat. 2017;231(2):248–59. https://doi.org/10.1111/joa.12631.CrossRefPubMedPubMedCentral

16.

Pavlova AV, Meakin JR, Cooper K, et al. Variation in lifting kinematics related to individual intrinsic lumbar curvature: an investigation in healthy adults. BMJ Open Sport Exerc Med. 4(1):e000374. https://doi.org/10.1136/bmjsem-2018-000374 published Online First:2018/07/31.

17.

Castro-Mateos I, Pozo JM, Cootes TF, et al. Statistical shape and appearance models in osteoporosis. Curr Osteoporos Rep. 2014;12(2):163–73. https://doi.org/10.1007/s11914-014-0206-3 published Online First: 2014/04/03.CrossRefPubMed

18.

Faber BG, Baird D, Gregson CL, et al. DXA-derived hip shape is related to osteoarthritis:findings from in the MrOS cohort. Osteoarthritis and cartilage / OARS, osteoarthritis research society. 2017;25(12):2031–8. https://doi.org/10.1016/j.joca.2017.09.006 published Online First:2017/09/25.CrossRef

19.

Kalichman L, Li L, Hunter DJ, et al. Association between computed tomography-evaluated lumbar lordosis and features of spinal degeneration, evaluated in supine position. Spine J. 2011;11(4):308–15. https://doi.org/10.1016/j.spinee.2011.02.010 published Online First: 2011/04/09.CrossRefPubMedPubMedCentral

20.

Endo K, Suzuki H, Tanaka H, et al. Sagittal spinal alignment in patients with lumbar disc herniation. Eur Spine J. 2010;19(3):435–8. https://doi.org/10.1007/s00586-009-1240-1 published Online First: 2010/01/22.CrossRefPubMed

21.

Aspden RM. The spine as an arch. A new mathematical model. Spine. 1989;14(3):266–74 published Online First: 1989/03/01.CrossRef

22.

Adams MA, Bogduk N, Burton K, et al. [2013] The Biomechanics of Back Pain: Churchill Livingstone Elsevier.

23.

Barrey C, Jund J, Noseda O, et al. Sagittal balance of the pelvis-spine complex and lumbar degenerative diseases. A comparative study about 85 cases. E Spine J. 2007;16(9):1459–67. https://doi.org/10.1007/s00586-006-0294-6.CrossRef

24.

Wren TAL, Ponrartana S, Aggabao PC, et al. Increased lumbar Lordosis and smaller vertebral cross-sectional area are associated with Spondylolysis. Spine. 2018;43(12):833–8. https://doi.org/10.1097/brs.0000000000002480 published Online First: 2017/11/03.CrossRefPubMed

25.

Schwab F, Dubey A, Pagala M, Gamez L, Farcy JP. Adult scoliosis: a health assessment analysis by SF-36. Spine. 2003;28(6):602–6.PubMed

26.

Ploumis A, Liu H, Mehbod AA, Transfeldt EE, Winter RB. A correlation of radiographic and functional measurements in adult degnerative scoliosis. SPine. 2009;34(15):1581–4. https://doi.org/10.1097/BRS.0b013e31819c94cc.CrossRefPubMed

27.

Modic MT, Ross JS. Lumbar Degenerative Disk Disease. Radiology. 2007;245(1):43–61.CrossRef

28.

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.CrossRef

Title: Is intrinsic lumbar spine shape associated with lumbar disc degeneration? An exploratory study
Authors: Janet A. Deane
Anastasia V. Pavlova
Adrian K. P. Lim
Jennifer S. Gregory
Richard M. Aspden
Alison H. McGregor
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Magnetic Resonance Imaging
Magnetic Resonance Imaging
Back Pain
Back Pain
Back Pain
Published in: BMC Musculoskeletal Disorders / Issue 1/2020
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-020-03346-7

At a glance: The STEP trials

Springer Medicine

Is intrinsic lumbar spine shape associated with lumbar disc degeneration? An exploratory study

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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