Browsing by Author "Sääksjärvi, Simo"

Study Design: A prospective follow-up study. Objective: To investigate if early lumbar disc degeneration (DD) in young low back pain (LBP) patients predicts progression of degenerative changes, pain, or disability in a 30-year follow-up. Summary of Background Data: MRI is an accurate method for studying degenerative changes in intervertebral discs. Decreased signal intensity (SI) can be used as indication of decreased water content. Long-term prognosis of early DD remains unclear. Methods: In an earlier study, 75 conscripts aged 20 years with LBP, had their lumbar spine examined by MRI. At a follow-up of 30 years, the subjects were contacted; 35/69 filled a pain and disability questionnaire, and 26/35 were also re-examined clinically and by MRI. The images were evaluated for decreased SI and other degenerative changes. Association between decreased SI of a disc at baseline and the presence of more severe degenerative changes in the same disc space at follow-up was analyzed using Fisher’s exact test. Association between decreased baseline SI and pain/disability scores from the questionnaire was analyzed with Kruskal-Wallis H test. Results: The total number of lumbar discs with decreased SI increased from 23/130 (18%) to 92/130 (71%) – from 0.9 to 3.5 per subject during the follow-up. Distribution of DD changed from being mostly in L4 – L5 and L5 – S1 discs to being almost even between the four lowermost discs. Discs that had even slightly decreased SI at baseline were more likely to have severely decreased SI at follow-up, compared to healthy discs (57% vs 11%, p<0.001). Other degenerative changes were also more common in these discs. Severity of DD at baseline did not have a significant association with current pain or disability. Conclusions: In young LBP patients, early degeneration in lumbar discs predicts progressive degenerative changes in the respective discs, but not pain, disability, or clinical symptoms.