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


BACKGROUND
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.


CONCLUSIONS
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.
Hicks
Gregory E
GE
Department of Physical Therapy, University of Delaware, Newark, DE 19716, USA. ghicks@udel.edu
Morone
Natalia
N
Weiner
Debra K
DK
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000473:pathology; D016022:Case-Control Studies; D002908:Chronic Disease / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology*; D007592:Joint Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology*; D017116:Low Back Pain / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D010147:Pain Measurement; D015995:Prevalence; D011859:Radiography; D011871:Radiology / Q000379:methods; D012720:Severity of Illness Index; D017678:Sex Distribution; D013130:Spinal Stenosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology; D021801:Zygapophyseal Joint / Q000473:pathology*