title: Chronic low back pain and its association with lumbar vertebrae and intervertebral disc changes in adults. A case control study.
abstract: OBJECTIVE
  This study was done to determine the association between chronic low back pain and vertebral fractures, intervertebral disc space (IDS) narrowing, vertebral osteophytes and spondylolisthesis among adults.
  
  
  METHODS
  This case control study was done in Sri Lanka. Cases were patients with low back pain and controls were without low back pain. Postero-anterior and lateral radiographs of lumbar sacral spine of both groups were studied. To detect vertebral fractures in fourth and fifth lumbar vertebrae, anterior and posterior heights of vertebrae were measured using a Vernier caliper and antero-posterior ratio (A/P) was calculated. Having an A/P ratio value of < 0.89 was considered as a vertebral fracture. Presence of disc space narrowing, vertebral osteophytes and spondylolisthesis was assessed by two radiologists working independently. Bivariate and logistic regression analysis was done to find associations.
  
  
  RESULTS
  There were 140 cases and 140 controls. Mean (SD) age for cases was 51.6 (17) years. Mean (SD) age for controls was 50 (15) years. Females made up 62% of cases and controls. Fifth lumbar vertebral fracture (odds ratio [OR] = 10.2; P = 0.001), fourth lumbar vertebral fracture (OR = 2.5; P = 0.017) and IDS narrowing (OR = 4.15, P = 0.009) had a significant association with low back pain and vertebral osteophytes and spondylolisthesis did not have a significant association with low back pain.
  
  
  CONCLUSIONS
  Only vertebral fractures and IDS narrowing had a significant association with chronic low back pain.
authors.affiliation: Department of Anatomy, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
authors.forename: Aranjan L
authors.initials: AL
authors.lastname: Karunanayake
authors.affiliation: Department of Public Health, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
authors.forename: Arunasalam
authors.initials: A
authors.lastname: Pathmeswaran
authors.affiliation: National Hospital, Colombo, Sri Lanka.
authors.forename: Lalith S
authors.initials: LS
authors.lastname: Wijayaratne
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D059350:Chronic Pain / Q000000981:diagnostic imaging / Q000209:etiology*; D005260:Female; D006801:Humans; D007403:Intervertebral Disc / Q000000981:diagnostic imaging; D055959:Intervertebral Disc Degeneration / Q000150:complications* / Q000000981:diagnostic imaging; D016015:Logistic Models; D017116:Low Back Pain / Q000000981:diagnostic imaging / Q000209:etiology*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010147:Pain Measurement; D012307:Risk Factors; D016103:Spinal Fractures / Q000150:complications* / Q000000981:diagnostic imaging; D013128:Spinal Osteophytosis / Q000150:complications / Q000000981:diagnostic imaging; D013168:Spondylolisthesis / Q000150:complications / Q000000981:diagnostic imaging; D013188:Sri Lanka
keywords: degeneration; intervertebral disc; low back pain; spondylolisthesis; vertebral fractures; vertebral osteophytes