An in vivo study exploring correlations between early-to-moderate disc degeneration and flexion mobility in the lumbar s
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ORIGINAL ARTICLE
An in vivo study exploring correlations between early‑to‑moderate disc degeneration and flexion mobility in the lumbar spine Alan Breen1 · Fiona Mellor2 · Andrew Morris2 · Alexander Breen2 Received: 27 September 2019 / Revised: 14 June 2020 / Accepted: 1 July 2020 © The Author(s) 2020
Abstract Purpose Early disc degeneration (DD) has been thought to be associated with loss of spine stability. However, before this can be understood in relation to back pain, it is necessary to know the relationship between DD and intervertebral motion in people without pain. This study aimed to find out if early-to-moderate DD is associated with intervertebral motion in people without back pain. Methods Ten pain-free adults, aged 51–71, received recumbent and weight bearing MRI scans and quantitative fluoroscopy (QF) screenings during recumbent and upright lumbar flexion. Forty individual level and 10 composite (L2-S1) radiographic and MRI DD gradings were recorded and correlated with intervertebral flexion ROM, translation, laxity and motion sharing inequality and variability for both positions. Results Kinematic values were similar to previous control studies. DD was evidenced up to moderate levels by both radiographic and MRI grading. Disc height loss correlated slightly, but negatively with flexion during weight bearing flexion (R = − 0.356, p = 0.0.025). Composite MRI DD and T2 signal loss evidenced similar relationships (R = − 0.305, R = − 0.267) but did not reach statistical significance (p = 0.056, p = 0.096). No significant relationships between any other kinematic variables and DD were found. Conclusion This study found only small, indefinite associations between early-to-moderate DD and intervertebral motion in healthy controls. Motion sharing in the absence of pain was also not related to early DD, consistent with previous control studies. Further research is needed to investigate these relationships in patients. Keywords Back pain · Disc degeneration · Instability · Imaging
Introduction The role of disc degeneration (DD) in the biomechanics of chronic back pain has been unclear for many years and important questions remain outstanding. For example, it has long been theorised that early DD is associated with ‘dysfunction’, that progression is followed by an ‘unstable’ Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00586-020-06526-0) contains supplementary material, which is available to authorized users. * Alan Breen [email protected] 1
Faculty of Science and Technology, Bournemouth University, Poole BH12 5BB, UK
Centre for Biomechanics Research, AECC University College, Parkwood Campus, Bournemouth BH5 2DF, UK
2
phase, and advanced degeneration brings ‘stabilisation’ [1]. However, providing evidence for this, let alone any association with pain, has proved difficult. Studies using flexion–extension radiographs and later MR imaging have failed to confirm an association between DD and abnormal movement [2, 3], probably due t
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