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Asian Spine J. 2019 Nov 5. doi: 10.31616/asj.2019.0046. [Epub ahead of print]

Significance of the Association between Disc Degeneration Changes on Imaging and Low Back Pain: A Review Article.

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Department of Orthopaedic and Traumatology, Cipto Mangukusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
Stem Cell and Tissue Engineering Cluster, Cipto Mangukusumo Hospital, MERC Faculty of Medicine, University of Indonesia, Jakarta, Indonesia.


Low back pain (LBP) is a major health issue resulting in a huge economic burden on the community. It not only increases the medical costs directly, but also raises the disability and loss of productivity in the general population. Symptoms include local pain over the spinal area, pain radiating to the lower leg, stiffness, and muscle tension. LBP is strongly linked with intervertebral disc degeneration that is further associated with the disruption of the complex anatomy of nucleus pulposus, annulus fibrosus, and adjacent supporting structures of the spine. Change in the shape and intensity of nucleus pulposus, decreased disc height, disc herniation, vertebral endplate changes, presence of osteophyte, and posterior high intensity zones are degenerative changes found in imaging studies. Every feature is considered while grading the severity score. Modic changes, DEBIT (disc extension beyond interspace) score, and Pfirrmann criteria are some of the scoring criteria used for evaluating disc degeneration severity. Moreover, the total number and contiguous pattern of affected discs play a crucial role in symptom generation of back pain. Many studies have reported asymptomatic patients. Thus, the correlation between degeneration severity found in imaging study and symptom severity of LBP remain unclear. This review discusses and summarizes the available literature on the significance of the association between the severity of degenerative changes found in imaging study with the presence and intensity of LBP.


Diagnostic imaging; Intervertebral disc degeneration; Low back pain

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