Prevalence of radiographic findings in individuals with chronic low back pain screened for a randomized controlled trial: secondary analysis and clinical implications

Abstract

Objective: The purpose of this study is to measure the prevalence of graded disc degeneration, spondylolisthesis, transitional segmentation, and the distribution of sacral slope in patients 21 to 65 years of age with chronic low back pain (CLBP).

Methods: This retrospective study analyzed 247 digital lumbar radiographic series obtained during a randomized controlled trial of chiropractic patients with CLBP. Chronic low back pain was defined as pain in the low back lasting 12 weeks or longer. Radiographic findings of disc degeneration, spondylolisthesis, and lumbosacral transitional segmentation were graded by 2 authors using established classification criteria. Sacral slope was measured with a digital tool contained within imaging software.

Results: Lumbosacral transitional segments graded I to IV (Castellvi classification) were present in 14% of cases. Lumbar disc degeneration was most prevalent at L3-4 (49%), followed by L4-5 (42%), L2-3 (41%), L5-S1 (37%), and L1-2 (29%). Isthmic spondylolisthesis was present in 5% of cases, with L5 the most common location. Degenerative spondylolisthesis demonstrated a prevalence of 18%, most commonly occurring at L4. The prevalence of degenerative spondylolisthesis was 51% for women aged 50 to 59 years and 24% for men in the same age range.

Conclusions: Moderate-severe disc degeneration, multilevel disc narrowing, and degenerative spondylolisthesis were common in individuals with CLBP with age more than 40 years. Isthmic spondylolisthesis was not more prevalent than what has been reported in other populations. Transitional segmentation was identified in a minority of participants, with some of these exhibiting accessory joints or fusion. Mean sacral slope in individuals with CLBP was not substantially different from mean slopes reported in other populations.

Keywords: Chiropractic; Intervertebral Disc Degeneration; Low Back Pain; Lumbosacral Region; Prevalence; Radiography; Spondylolisthesis.

Conflict of interest statement

CONFLICTS OF INTEREST

No conflicts of interest were reported for this study.

Copyright © 2014 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

Top row: Examples of disc narrowing graded as mild (with normal disc above), moderate, and severe from left to right. Bottom row: Examples of osteophytes graded as mild, moderate, and severe from left to right.

Figure 2

Left: illustrates an isthmic spondylolisthesis at L5 (Meyerding grade 2, i.e. between 25% and 50% anterior translation across the sacral plateau) and a degenerative spondylolisthesis at L4 (Meyerding grade 1, i.e. less than 25% anterior translation across the body of L5). Right: demonstrates sacral slope measurement using Catella 5.0 PACS digital software.

Figure 3

Lumbosacral transitional vertebrae (Castellvi Classification) Left: Type IA, circle showing unilateral dysplastic (enlarged) transverse process. Center: Type IIA, arrow showing unilateral dysplastic transverse process with accessory joint. Right: Type III a, arrows showing unilateral dysplastic transverse process with bony union. Type IV or mixed (not shown) is classified as type II and type III on opposite sides. (Bilateral presentations of types I–III are designated with the letter b)