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Bony stress in the lumbar spine is associated with intervertebral disc degeneration and low back pain: a retrospective case–control MRI study of patients under 25 years of age

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Abstract

Purpose

Abnormal stress in the lumbar vertebra, also known as bony stress, can be a precursor to degenerative changes which may manifest as low back pain (LBP). However, the prevalence of bony stress in the lumbar spine and its relationship with degenerative changes and LBP is unclear. The purpose of this study was to evaluate the prevalence of bony stress in the lumbar spine and its relationship with intervertebral disc (IVD) degeneration, facet osteoarthritis and LBP in patients under 25 years of age.

Methods

A retrospective case–control study of 130 patients under 25 years of age was conducted from a population of 493 patients who had lumbar MRI across three imaging centres over three years. A cohort of 55 consecutive patients with bony stress was identified. A control group of consecutive patients (n = 75) without bony stress was also selected from the population.

Results

Bony stress was prevalent in 11% (95% CI [8.4–14.5%]) of patients and was not diagnosed in 36% (95% CI [22–55%]) of these cases. Patients with bony stress had over twofold (OR 2.3, 95% CI [1.1–4.8]) and fivefold (OR 5.3, 95% CI [2.11–13.3]) higher likelihood of having IVD degeneration and LBP, respectively, when compared with the control group. Bony stress was not found to be associated with facet osteoarthritis.

Conclusion

Bony stress in the lumbar spine was prevalent in 11% of patients under 25 years of age. It was commonly undiagnosed in radiology reports (not reported in 36% of the cases). Being significantly associated and with an increased likelihood of IVD degeneration and LBP, we posit that bony stress is likely a symptomatic and clinically meaningful diagnostic entity in the assessment of LBP.

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Acknowledgements

The authors thank Sue Pohlmann at St. George MRI and Healthcare Imaging for providing logistical support and access to de-identified patient MRI data, Ritin Fernandes and Laura Ellwood at the Centre for Research in Nursing and Health for advice on statistical analyses and valuable inputs on this manuscript.

Funding

This work was supported by an Australian Government Research Training Program Scholarship and a University Postgraduate Award to KS, a National Health and Medical Research Council Australia Career Development Fellowship (GNT1123014) to DS, and internal research funds from Spine Service.

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Authors and Affiliations

  1. Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, VIC, Australia

    Daniel Chepurin

  2. Spine Labs, Department of Orthopaedic Surgery, L3 WR Pitney Building, St. George and Sutherland Clinical School, Faculty of Medicine, The University of New South Wales, St. George Hospital Campus, Kogarah, NSW, Australia

    Uphar Chamoli, Kyle Sheldrick & Ashish D. Diwan

  3. School of Biomedical Engineering, Faculty of Engineering and Information Technology, University of Technology Sydney, Ultimo, NSW, Australia

    Uphar Chamoli

  4. Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia

    Samuel Lapkin

  5. Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia

    David Scott

  6. St. George MRI, Healthcare Imaging, Kirk Place, Kogarah, NSW, Australia

    Jeff Kuan

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Correspondence to Uphar Chamoli.

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Chepurin, D., Chamoli, U., Sheldrick, K. et al. Bony stress in the lumbar spine is associated with intervertebral disc degeneration and low back pain: a retrospective case–control MRI study of patients under 25 years of age. Eur Spine J 28, 2470–2477 (2019). https://doi.org/10.1007/s00586-019-06148-1

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  • DOI: https://doi.org/10.1007/s00586-019-06148-1

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