Special Poster Session 51st International Society for the Study of the Lumbar Spine Annual Meeting 2025

Sex- and Age-Specific Prevalence of Lumbar Intervertebral Degeneration and Its Association with Chronic Back Pain: First Insights from a Large-Scale Spine MRI Analysis on the German National Cohort (116201)

Matan Atad 1 , Amir Jamaludin 2 , Jannis Bodden 3 , Timor Kadir 1 , Jeremy Fairbank 2 , Jill Urban 4 , Robert Graf 3 , Hendrik Möller 3 , Hanna Schön 3 , Daniel Rückert 3 , Jan Kirschke 3
  1. Visual Geometry Group, Department of Engineering Science , University of Oxford, Oxford, United Kingdom
  2. Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
  3. Technical University of Munich, München, BY, Germany
  4. Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom

Introduction

Lumbar intervertebral disc (IVD) degeneration is a leading cause of lower back pain and disability [Peng et. al, 2013]. The Pfirrmann grading system quantitatively measures disc degeneration based on MRI imaging [Pfirrmann et. al, 2001]. We applied SpineNet [Jamaludin et. al, 2017], a pre-trained neural network, on 30,000 T2-weighted lumbar MRIs from the German National Cohort (NAKO), and assessed population-level patterns of Pfirrmann grades. We analyzed these data by age, sex, and self-reported chronic back pain to explore demographic and clinical correlations.

 

Methods

SpineNet inferred Pfirrmann grades (1–5, with 5 indicating severe degeneration) for each lumbar IVD (L1-S1). These results were grouped by age, sex, and self-reported chronic back pain status (experienced back pain for more than 3 months in the past). We performed statistical analyses to compare the prevalence of high grades (≥4) between subgroups. Differences in prevalence were also examined to assess whether demographic or clinical factors contributed to degenerative patterns.

 

Results

  • Sex Differences: Among females aged 20–70, the prevalence of Pfirrmann grades 4–5 increased significantly with age, reaching 54% by the 60-70 age group. Males exhibited a similar trend and prevalence but lower prevalence in the oldest age group (46%).
  • Back Pain Associations: Individuals reporting back pain had a higher prevalence of severe Pfirrmann grades. E.g., 55% of 60-year-olds and above with back pain had grades 4-5, compared to 47% without pain.
  • Age Correlations: Disc degeneration became more prevalent with age, particularly in lower lumbar levels (L4-S1), with grade 4+ observed in over 64% of 60-year-olds and above.

 

Discussion

Our findings confirm sex- and age-related differences in lumbar IVD degeneration patterns. The strong association between severe Pfirrmann grades and chronic back pain highlights the clinical relevance of disc degeneration for the study of lumbar spine conditions. This study demonstrates the utility of AI in large-scale population imaging studies, paving the way for better understanding and management of spine degeneration.

 

 

References

Peng, B. G. (2013). Pathophysiology, diagnosis, and treatment of discogenic low back pain. World journal of orthopedics, 4(2), 42.

Pfirrmann, C. W., Metzdorf, A., Zanetti, M., Hodler, J., & Boos, N. (2001). Magnetic resonance classification of lumbar intervertebral disc degeneration. spine, 26(17), 1873-1878.

Jamaludin, A., Kadir, T., & Zisserman, A. (2017). SpineNet: automated classification and evidence visualization in spinal MRIs. Medical image analysis, 41, 63-73.

 

Figures

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Figure 1: Prevalence of Pfirrmann grades in females for different age groups as indicated on the right.

 

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Figure 2: Prevalence of Pfirrmann grades in males for different age groups as indicated on the right.