RELATIONSHIP BETWEEN DISABILITY AND RADIOGRAPHIC FINDINGS OF LUMBAR DISK DEGENERATION IN SAMPLE OF IRAQI PATIENTS WITH MECHANICAL LOW BACKACHE
Objectives: Disability related to chronic low back pain (LBP) is a complex and multidimensional phenomenon all over the world. The prevalence of backache in middle age and elderly is up to 84%. This study aims to evaluate the associations of X-ray features of lumbar disk degeneration with severity of disability among patients with mechanical LBP.
Methods: A cross-sectional study was conducted on a total of 300 patients with chronic mechanical LBP. Severity of disability was measured using Modified Oswestry Disability Index and intensity of backache was assessed using numeric rating scale (0–10). X-ray features of lumbar disc degeneration according to Lane classification and spondylolisthesis were assessed in lateral recumbent lumbar X-rays.
Results: The mean age of our sample was 52.45±7.87 and 71.7% of involved patients were women. Most patients were recorded as overweight or obese. The findings of disk space narrowing were mild in 65.7%, moderate in 28.7%, and severe in 5.6%, where the presence of osteophytes were small in 76.9%, moderate in 20.5%, and large in 2.6%. Regarding disability, two-third of cases were focused on minimal disability, followed by moderate, severe, and crippled as (26%), (6%), and (2%), respectively. There was highly significant association between women and pain radiation to legs (p=0.004). Obesity and overweight had meaningless effects on all markers.
Conclusions: The severity of disability was significantly more in women, high intensity of lower back pain, presence of pain radiating to legs, moderate/severe disk space narrowing on X-ray, and disk degenerative disease score on X-ray, while age, presence of osteophytes and spondylolisthesis, body mass index, and pain duration were not associated with severity of disability.
2. Hüllemann P, Keller T, Kabelitz M, Gierthmühlen J, Freynhagen R, Tölle T, et al. Clinical manifestation of acute, subacute, and chronic low back pain in different age groups: Low back pain in 35,446 patients. Pain Pract 2018;18:1011-23.
3. Resnick DK, Choudhri TF, Dailey AT, Groff MW, Khoo L, Matz PG, et al. Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 9: Fusion in patients with stenosis and spondylolisthesis. J Neurosurg 2005;2:679-85.
4. World Health Organization. International Classification of Impairments, Disabilities and Handicaps: A Manual of Classification Relating to the Consequences of Disease. Geneva, World Health Organization; 1980.
5. Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. 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 2012;380:2163-96.
6. Vos T, Allen C, Arora M, Barber RM. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: A systematic analysis for the global burden of disease study 2015. Lancet 2016;388:1545-602.
7. Hoy DG, Smith E, Cross M, Sanchez-Riera L, Blyth FM, Buchbinder R, et al. Reflecting on the global burden of musculoskeletal conditions: Lessons learnt from the global burden of disease 2010 study and the next steps forward. Ann Rheum Dis 2015;74:4-7.
8. Reigo T, Timpka T, Tropp H. The epidemiology of back pain in vocational age groups. Scand J Prim Health Care 1999;1:17-21.
9. Fairbank JC, Couper J, Davies JB, O’brien JP. The Oswestry low back pain disability questionnaire. Physiotherapy 1980;66:271-3.
10. Fairbank JC, Pynsent PB. The Oswestry disability index. Spine 2000;25:2940-52; discussion 52.
11. Boonstra AM, Stewart RE, Köke AJ, Oosterwijk RF, Swaan JL, Schreurs KM, et al. Cut-off points for mild, moderate, and severe pain on the numeric rating scale for pain in patients with chronic musculoskeletal pain: Variability and influence of sex and catastrophizing. Front Psychol 2016;7:1466.
12. Emiliano NV, Roberto GV, Christiano ES, de Souza M. Clinical-radiographic correlation of degenerative changes of the spine-systemic review. Colun Colum 2016;15: 325-9.
13. World Health Organization. Obesity and Overweight: Fact Sheet. Available from: http://www.who.int/news-room/fact-sheets/detail/ obesity-and-overweight. [Last accessed on 2018 Jul 12].
14. Bydon M, Alvi MA, Goyal A. Degenerative lumbar spondylolisthesis: Definition, natural history, conservative management, and surgical treatment. Neurosurg Clin 2019;30:299-304.
15. Biglarian A, Seifi B, Bakhshi E, Mohammad K, Rahgozar M, Karimlou M, et al. Low back pain prevalence and associated factors in Iranian population: Findings from the national health survey. Pain Res Treatment 2012;2012:653060.
16. Shiri R, Karppinen J, Leino-Arjas P, Solovieva S, Viikari-Juntura E. The association between obesity and low back pain: A meta-analysis. Am J Epidemiol 2009;171:135-54.
17. Ahdhi GS, Subramanian R, Saya GK, Yamuna TV. Prevalence of low back pain and its relation to quality of life and disability among women in rural area of Puducherry, India. Indian J Pain 2016;30:111.
18. Koley S, Sandhu NK. An association of body composition components with the menopausal status of patients with low back pain in Tarn Taran, Punjab, India. J Life Sci 2009;1:129-32.
19. Craft RM, Mogil JS, Aloisi AM. Sex differences in pain and analgesia: The role of gonadal hormones. Eur J Pain 2004;8:397-411.
20. Galukande M, Muwazi S, Mugisa BD. Disability associated with low back pain in Mulago Hospital, Kampala Uganda. Afr Health Sci 2006;6:173-6.
21. Wang YX, Griffith JF. Effect of menopause on lumbar disk degeneration: Potential etiology. Radiology 2010;257:318-20.
22. Wang YX, Griffith JF, Ma HT, Kwok AW, Leung JC, Yeung DK, et al. Relationship between gender, bone mineral density, and disc degeneration in the lumbar spine: A study in elderly subjects using aneight-level MRI-based disc degeneration grading system. Osteoporos Int 2011;22:91-6.
23. Wáng YX. Postmenopausal Chinese women show accelerated lumbar disc degeneration compared with Chinese men. J Orthop Transl 2015;3:205-11.
24. La Touche R, Pérez-Fernández M, Barrera-Marchessi I, López-de- Uralde-Villanueva I, Villafañe JH, Prieto-Aldana M, et al. Psychological and physical factors related to disability in chronic low back pain. J Back Musculoskelet Rehabil 2019;32:603-11.
25. AL-Jumaily HF. Assessment of individual radiographic features of lumber disc degeneration influenced by age, gender and vertebral level. Iraqi J Community Med 2013;26:129-36.
26. Peterson CK, Bolton JE, Wood AR. A cross-sectional study correlating lumbar spine degeneration with disability and pain. Spine 2000;25:218.
27. Andersson GB. Epidemiological features of chronic low-back pain. Lancet 1999;354:581-5.
28. Güler M, Çapk?n E, Barçak ÖF, Karkucak M. The association between radiographic features in patients with lumbar spine degenerative changes and body mass index; a preliminary stereological study. Nob Med 2013;9:9-13.
29. Perera RS, Dissanayake PH, Senarath U, Wijayaratne LS, Karunanayake AL, Dissanayake VH. Associations between disc space narrowing, anterior osteophytes and disability in chronic mechanical low back pain: A cross sectional study. BMC Musculoskeletal Disord 2017;18:193.
30. Ren XS, Selim AJ, Fincke G, Deyo RA, Linzer M, Lee A, et al. Assessment of functional status, low back disability, and use of diagnostic imaging in patients with low back pain and radiating leg pain. J Clin Epidemiol 1999;52:1063-71.
31. Konstantinou K, Hider SL, Jordan JL, Lewis M, Dunn KM, Hay EM. The impact of low back-related leg pain on outcomes as compared with low back pain alone: A systematic review of the literature. Clin J Pain 2013;29:644-54.
32. Konstantinou K, Dunn KM, Ogollah R, Vogel S, Hay EM; ATLAS Study Research Team. Characteristics of patients with low back and leg pain seeking treatment in primary care: Baseline results from the ATLAS cohort study. BMC Musculoskelet Disord 2015;16:332.
33. Pye SR, Reid DM, Lunt M, Adams JE, Silman AJ, O’Neill TW. Lumbar disc degeneration: Association between osteophytes, end-plate sclerosis and disc space narrowing. Ann Rheum Dis 2007;66:330-3.
34. De Schepper EI, Damen J, van Meurs JB, Ginai AZ, Popham M, Hofman A, Koes BW, et al. The association between lumbar disc degeneration and low back pain: The influence of age, gender, and individual radiographic features. Spine 2010;35:531-6.
35. Kettler A, Wilke HJ. Review of existing grading systems for cervical or lumbar disc and facet joint degeneration. Eur Spine J 2006;15:705-18.
36. Goode AP, Marshall SW, Renner JB, Carey TS, Kraus VB, Irwin DDE, et al. Lumbar spine radiographic features and demographic, clinical, and radiographic knee, hip, and hand osteoarthritis. Arthritis Care Res 2012;64:1536-44.
37. Ashraf A, Farahangiz S, Jahromi BP, Setayeshpour N, Naseri M. Correlation between degree of radiologic signs of osteoarthritis and functional status in patients with chronic mechanical low back pain. Malays J Med Sci 2014;21:28-33.
38. Webb R, Brammah T, Lunt M, Urwin M, Allison T, Symmons D. Prevalence and predictors of intense, chronic, and disabling neck and back pain in the UK general population. Spine 2003;28:1195-202.
39. Salvetti MD, Pimenta CA, Braga PE, Corrêa CF. Disability related to chronic low back pain: Prevalence and associated factors. Rev Esc Enferm 2012;46:16-23.
40. Möller H, Sundin A, Hedlund R. Symptoms, signs, and functional disability in adult spondylolisthesis. Spine 2000;25:683-90.
41. Petersen T, Laslett M, Juhl C. Clinical classification in low back pain: Best-evidence diagnostic rules based on systematic reviews. BMC Musculoskelet Disord 2017;18:188.
This work is licensed under a Creative Commons Attribution 4.0 International License.
The publication is licensed under CC By and is open access. Copyright is with author and allowed to retain publishing rights without restrictions.