Degenerative lumbar disc and facet disease in older adults: prevalence and clinical correlates

Abstract

Study design: A case-control study of older adults with and without chronic low back pain (CLBP).

Objective: Compare and describe the radiographic severity of degenerative disc and facet disease in the lumbosacral spine of community-dwelling older adults with and without CLBP and to examine the relationship between spinal pathology and pain.

Summary of background data: Degenerative spinal pathology is often implicated as the primary reason for CLBP in older adults. Despite evidence that spinal pathology may be ubiquitous in older adults regardless of pain status, radiography continues to be heavily used in the diagnostic process.

Methods: Participants in this case-control study included 162 older adults (> or =65) with CLBP and an age and gender matched pain-free group of 158 people. CLBP was characterized as pain of at least moderate intensity occurring daily or almost everyday for at least 3 months. Radiographic severity of disc and facet disease was graded using a reliable and valid system.

Results: Results demonstrated that the presence of degenerative disc and facet pathology in older adults is ubiquitous, regardless of clinical status, with greater than 90% demonstrating some level of degeneration. Higher radiographic severity scores were associated with the presence of CLBP. In fact, presence of severe disc pathology was associated with 2-fold greater odds of having CLBP. But, radiographic severity of disc and facet disease was not associated with pain severity among those with CLBP.

Conclusion: From a research perspective, radiographic evaluation of spinal pathology provides additional information about older adults with CLBP compared to pain-free individuals, but its clinical utility for diagnostic purposes is still in question.

Figure 1

Percent of participants classified as having any DDD at a particular spinal level. PF = pain-free. Any disc disease: having a score of >0 on 0 to 3 scale at any spinal level. *P < 0.05.

Figure 2

Percent of participants classified as having severe DDD at a particular spinal level. PF = pain-free. Severe disc disease: having a score of >2 on 0 to 3 scale at any spinal level. *P < 0.05, **P < 0.001.

Figure 3

Percent of participants classified as having any right-sided DFD at a particular spinal level. PF = pain-free. Any facet disease: having a score of >0 on 0 to 3 scale at any spinal level. *P < 0.05.

Figure 4

Percent of participants classified as having severe right-sided DFD at a particular spinal level. PF = pain-free. Severe facet disease: having a score of >2 on 0 to 3 scale at any spinal level.