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Archived Comments for: Body mass index is associated with lumbar disc degeneration in young Finnish males: subsample of Northern Finland birth cohort study 1986

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  1. Low back pain and sciatica; relationship of imaging findings to clinical symptoms.

    Brian Sweetman, NHS

    8 May 2013

    Takatalo et al have recently reported MRI studies of disk degeneration in the young adult Oulo cohort. In the latest article (1) body mass index and smoking were linked to disk degeneration in males. In the slightly earlier article (2) the same MRI data was used to check which changes might be the causes of actual back pain symptoms and in particular the relationship between disk degeneration and Schmorls nodes. They include a helpful review of the modern literature in their following discussion. However they conclude that it is difficult to prove cause and effect and that it would need a prospective study with annual MRI studies for many years to get round this problem. To add to these deliberations it is perhaps interesting to draw attention to similar studies undertaken with plain x-rays from the era prior to MRI (3).
    Factor analyses were undertaken using ten x-ray features from lumbosacral films. There were 301 teen and adult patients all with low back pain problems and some also had sciatica. The first factor linked spondylolisthesis at L5/S1 with spondylolysis which is well known. The second factor focused on Schmorls nodes and suggested links with the disc margin osteophytes which probably reflect disc degeneration.. This second factor also seemed to include spina bifida occulta and spondylolisthesis at L4/5 as well. A recent review of the literature draws together a web of associations including the above findings and a spread of possible causative mechanisms. The third factor focused on scoliosis linking with tip to tip of transverse processes not being widest at the L4 level. The fourth factor was a horizontal facet joint at the lumbosacral junction which was poorly related to most of the above. These aspects may all be worth incorporating in future studies. But what makes this old x-ray study of interest was that it was mainly factors 2 & 3 that were useful in helping classify various subgroups within the common presentations of low back pain, which had been distinguished using cluster analysis (4,5). This seems to hint at real clinical associations between x-ray findings and morbidity even though this part of the study was not of prospective design.

    Brian Sweetman FRCP, MD, PhD.
    Swansea, UK.

    1. Takatalo J, Karppinen J, Taimela S, Niinimäki J, Laitinen J, Sequeiros RB, Paananen M, Remes J, Näyhä S, Tammelin T, Korpelainen R, Tervonen O. Body mass index is associated with lumbar disc degeneration in young Finnish males: subsample of Northern Finland birth cohort study 1986. BMC Musculoskeletal Disorders 2013, 14:87. doi:10.1186/1471-2474-14-87
    2. Takatalo J, Karppinen J, Niinimäki J, Taimela S, Mutanen P, Sequeiros RB, Näyhä S, Järvelin M-R, Kyllönen E, Tervonen O. Association of modic changes, Schmorl's nodes, spondylolytic defects, high-intensity zone lesions, disc herniations, and radial tears with low back symptom severity among young Finnish adults. Spine 2011; 37(14):1231-9.
    3. Sweetman BJ. Numerical classification of common low back pain. MD Thesis, London University, 1985.
    4. Sweetman BJ, Sweetman SJ. Midline back pain: a literature review. International Musculoskeletal Medicine (ISSN: 17536146) Appeared or available online: 09 March 2013. DOI: 10.1179/1753614613Z.00000000036
    5. Sweetman BJ. Low Back Pain: some real answers. tfm Publishing Ltd, Harley SY5 6LX, UK, 2005.

    Competing interests