Oral Presentation 51st International Society for the Study of the Lumbar Spine Annual Meeting 2025

Longitudinal progression of disc degeneration over 23 years from adolescence to adulthood (115452)

Teija Lund 1 , Anni Aavikko 2 , Leena Ristolainen 3 , Hannu Kautiainen 4 , Martina Lohman 1 , Dietrich Schlenzka 3
  1. Helsinki University Hospital, Helsinki, HUS, Finland
  2. Orthopaedics and traumatology, Paijat-Hame Central Hospital, Lahti, Paijat-Hame, Finland
  3. Research Institute Orton, Helsinki, Finland
  4. Medcare, Espoo, Finland

Introduction Imaging findings of disc degeneration (DD) are present in high proportions in both symptomatic and asymptomatic individuals and increase with age. In adults, the peak progression of DD occurs before the age of 50 (1) with a significant genetic influence at younger age (2). In the present study, we aimed to investigate the individual progression of DD and its relationship to life-time occurrence of low back pain (LBP) in a group of healthy volunteers from adolescence to adulthood.

 

Methods This is a longitudinal observational study of healthy volunteers at the age of 11, 19 and 34 years comprising of a structured interview, a clinical examination, and a lumbar spine magnetic resonance imaging (MRI). The interview inquired about life-time occurrence of LBP without trauma. A musculoskeletal radiologist and two spine surgeons analyzed the MRIs (mid-sagittal T2-weighted images) using the 5-grade Pfirrmann classification to assess the intervertebral discs from L1/L2 to L5/S1. Discs classified as Pfirrmann grade 3 or higher were regarded as degenerated. We also calculated the Pfirrmann Summary Score (PSS) by adding up the scores of the individual discs (range 5-25). We used the Generalized Estimating Equation (GEE) model to establish the rate of Pfirrmann grade 3 or higher discs at each study time point and the annual change in PSS from age 34 backwards.

 

Results Forty study subjects had a full data set at all three study time points. At age 34, there were no statistically significant differences between the subjects with a Pfirrmann grade lower than 3 or 3 or higher in the demographic or clinical parameters. There was a significant increase in PSS in both groups over time with a statistically significant difference between the groups at age 19 and age 34 (Fig 1 left). In the whole study group, the annual change in PSS was significantly greater from age 11 to age 19 than from age 19 to age 34 (Fig 1 right). The annual change of PSS from age 11 to age 19 was 0.55 (95% CI 0.48 to 0.63) and from age 19 to age 34 0.08 (95% CI 0.05 to 0.11). Subjects with a Pfirrmann grade 3 or higher in at least one lumbar disc reported significantly more LBP at age 19 and age 34 compared to those with Pfirrmann grade lower than 3 discs when adjusted for sex, BMI, smoking and physical activity (Fig 2).

 

Discussion Progression of DD is age dependent. In the present study, the pubertal growth spurt emerged as the critical phase with annual progression of DD more pronounced from age 11 to age 19 than from age 19 to age 34. Throughout the study period subjects with DD (defined as any lumbar disc with Pfirrmann grade 3 or higher) reported more LBP compared to subjects with no DD. Compared to Pfirrmann grade 3 or higher, the role of Pfirrmann grade lower than 3 to the occurrence of LBP decreased over the study period.  

Fig 1.

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Fig 2.

  1. (1) Deguchi et al. Eur Spine J 2024;33:3334-3342
  2. (2) Williams et al. Ann Rheum Dis 2011;70:1203-1207