title: The association of combination of disc degeneration, end plate signal change, and Schmorl node with low back pain in a large population study: the Wakayama Spine Study.
abstract: BACKGROUND
  Disc degeneration (DD) reportedly causes low back pain (LBP) and is often observed concomitantly with end plate signal change (ESC) and/or Schmorl node (SN) on magnetic resonance imaging.
  
  
  OBJECTIVE
  The purpose of this study was to examine the association between DD and LBP, considering ESC and/or SN presence, in a large population study.
  
  
  METHODS
  Cross-sectional population-based study in two regions of Japan.
  
  
  METHODS
  Of 1,011 possible participants, data from 975 participants (324 men, 651 women; mean age, 66.4 years; range, 21-97 years) were included.
  
  
  METHODS
  Prevalence of DD, ESC, and SN alone and in combination in the lumbar region and the association of these prevalence levels with LBP.
  
  
  METHODS
  Sagittal T2-weighted images were used to assess the intervertebral spaces between L1-L2 and L5-S1. Disc degeneration was classified using the Pfirrmann classification system (grades 4 and 5 indicated degeneration); ESC was defined as a diffuse high signal change along either area of the end plate, and SN was defined as a small well-defined herniation pit with a surrounding wall of hypointense signal. Logistic regression analysis was used to determine the odds ratios (ORs) and confidence intervals (CIs) for LBP in the presence of radiographic changes in the lumbar region and at each lumbar intervertebral level, compared with patients without radiographic change, after adjusting for age, body mass index, and sex.
  
  
  RESULTS
  The prevalence of lumbar structural findings was as follows: DD alone, 30.4%; ESC alone, 0.8%; SN alone, 1.5%; DD and ESC, 26.6%; DD and SN, 12.3%; and DD, ESC, and SN, 19.1%. These lumbar structural findings were significantly associated with LBP in the lumbar region overall, as follows: DD, ESC, and SN, OR 2.17, 95% CI 1.2-3.9; L1-L2, OR 6.00, 95% CI 1.9-26.6; L4-L5, OR 2.56, 95% CI 1.4-4.9; and L5-S1, OR 2.81, 95% CI 1.1-2.3. The combination of DD and ESC was significantly associated with LBP as follows: L3-L4, OR 2.43, 95% CI 1.5-4.0; L4-L5, OR 1.82, 95% CI 1.2-2.8; and L5-S1, OR 1.60, 95% CI 1.1-2.3.
  
  
  CONCLUSIONS
  Our data suggest that DD alone is not associated with LBP. By contrast, the combination of DD and ESC was highly associated with LBP.
authors.affiliation: Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-8510, Japan.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Teraguchi
authors.affiliation: Department of Joint Disease Research, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Yoshimura
authors.affiliation: Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-8510, Japan. Electronic address: hashizum@wakayama-med.ac.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hashizume
authors.affiliation: Department of Clinical Motor System Medicine, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Muraki
authors.affiliation: Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-8510, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamada
authors.affiliation: Department of Joint Disease Research, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Oka
authors.affiliation: Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-8510, Japan.
authors.forename: Akihito
authors.initials: A
authors.lastname: Minamide
authors.affiliation: Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-8510, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nakagawa
authors.affiliation: Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-8510, Japan.
authors.forename: Yuyu
authors.initials: Y
authors.lastname: Ishimoto
authors.affiliation: Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-8510, Japan.
authors.forename: Keiji
authors.initials: K
authors.lastname: Nagata
authors.affiliation: Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-8510, Japan.
authors.forename: Ryohei
authors.initials: R
authors.lastname: Kagotani
authors.affiliation: Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
authors.forename: Sakae
authors.initials: S
authors.lastname: Tanaka
authors.affiliation: Japan Community Health Care Organization Tokyo Shinjuku Medical Center, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo 160-8402, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kawaguchi
authors.affiliation: Rehabilitation Services Bureau, National Rehabilitation Center for Persons with Disabilities, 1 Namiki 4-chome, Tokorozawa City, Saitama 359-8555, Japan.
authors.forename: Kozo
authors.initials: K
authors.lastname: Nakamura
authors.affiliation: Department of Joint Disease Research, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Akune
authors.affiliation: Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-8510, Japan.
authors.forename: Munehito
authors.initials: M
authors.lastname: Yoshida
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000150:complications* / Q000453:epidemiology; D007405:Intervertebral Disc Displacement / Q000150:complications* / Q000453:epidemiology; D007564:Japan; D017116:Low Back Pain / Q000453:epidemiology / Q000209:etiology*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011859:Radiography
keywords: Disc degeneration; End plate signal change; Large population study; Low back pain; ROAD study; Schmorl node